Pdf Book Name: Tintinalli’s Emergency Medicine Manual, 8th Edition
Author: Rita K. Cydulka, David M. Cline, O. John Ma et al.
Pages: 1088 pages
File size: 22 MB
File format: PDF,EPUB
Tintinalli’s Emergency Medicine Manual, 8th Edition Pdf Book Description:
Airway assessment and management is one of the most critical interventions that emergency physicians perform. Intubation is not always necessary, however, and rushing into invasive airway management before initial resuscitation can be problematic. Perform a rapid clinical airway assessment which includes noting the patient’s level of responsiveness, skin color, respiratory rate, and depth of respirations. Obtain oxygen saturation and capnography unless the patient is in impending or actual cardiac arrest. The goal is to determine if the patient is maintaining and protecting their airway and meeting critical oxygenation and ventilation goals. Nothing should be placed in the pharynx to assess gag reflex. Emergent and immediate decisions on airway management may proceed before obtaining blood gases and x-rays.Open the airway and initiate low-volume ventilation unless following cardiocerebral resuscitation protocols. The primary focus of initial cardiopulmonary resuscitation is on establishing quality chest compressions and evaluating for a shockable rhythm. Once these priorities are addressed, the airway can be further managed with an extraglottic device or endotracheal intubation. Position the patient to open the airway, drain secretions and maximize oxygenation and ventilation, while maintaining cervical stabilization precautions if indicated.
Place conscious patients in a sitting position, if possible, and unconscious patients on their side unless they require urgent invasive procedures. Patients who are unable to maintain an open airway should have one or two properly sized nasal trumpets placed if they are not anticoagulated or at risk for mid-face fractures; an oral airway may be used instead of, or in addition to, the nasal airways if no gag reflex present. Provide supplemental oxygen if the room air saturation is below 94% with the goal of increasing saturation to above 94%; high flow oxygen should be avoided when possible. Begin mask ventilation for patients with poor respiratory effort. Patients should be placed in a sniffing or ramped position with airway adjuncts as previously discussed. Apply a properly fitted mask with one provider dedicated to maintaining a tight seal while a second provider or mechanical ventilator provides just enough volume to raise the chest. Two different hand grips are described to achieve a mask seal during two-person mask ventilation with the “T-E” preferred over the “E-C” in most cases (Fig. 1-1). If you are unable to achieve a tight mask seal consider placing an extraglottic device if there is no gag reflex or other contraindication. If good chest rise is noted but saturations remain poor despite supplemental oxygen, add PEEP
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