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Objectives
Introduction
ABC of resuscitation
Focus is to ensure the airway is open, assess
patient breathing and support gas exchange
Secondary goal is preservation of
cardiovascular stability and the prevention of
aspiration
Healthcare providers must be skilled in
manually supporting the airway and
providing the essential process of
oxygenation and ventilation
Assessment
First step : Assess airway patency and
spontaneous breathing. Look, listen and feel
for air movement.
Observe the level of consciousness and
determine if respiratory efforts are absent
proceed to manual support and assist
ventilation while preparing to establish the
airway
Identify injury (e.g possible cervical spine
fracture)
Observe chest expansion, to assess respiratory
muscle activity and adequate ventilation
Assessment
Observe for suprasternal, supraclavicular or
intercostal retraction, tracheal tug or nasal
flaring that represent respiratory distress
Auscultate over the neck and chest for breath
sounds. Complete airway obstruction if there
is chest movement but breath sound are
absent. Incomplete obstruction if we hear
snoring, stridor, gurgling or noisy breathing.
Assess the protective airway reflexes (cough
and gag). Absence of protective reflexes need
for airway support.
Oxygen supplementation
Nasal cannula O2 100% 0,5-5 lt/m (FiO2 0,400,50)
Venturi mask O2 100% 6lt/m
Aerosol face mask
Reservoar face mask (rebreathing or non
rebreathing
Airway obstruction
Airway obstruction :
The majority of preventable deaths
following trauma occur as a result of airway
obstruction.
Obstruction may occur at any point within
the airway, from the upper airways to the
bronchi deep within the chest.
Recognition of airway
obstruction
LOOK for chest/abdominal movement
LISTEN at mouth and nose for breath sounds and
abnormal noises
FEEL at mouth and nose for expired air
Abnormal sounds in airway obstruction
Snoring - due to obstruction of upper airway by
the tongue
Gurgling - due to obstruction of upper airway by
liquids (blood, vomit)
Wheezing - due to narrowing of the lower airways
Complete airway obstruction is silent.
Oral airways
Will stimulate vomiting and movement in
conscious or semi-conscious casualties
This may result in;
worsening airway problems
cervical spine compromise
Nasal airways
Will cause bleeding from the nose in a large
number of cases.
This will result in worsening airway problems so use
only as a last resort.
Indication :
- Patient is apneic
- Spontaneous tidal volume is inadequate
- Reduce the work of breating
- Hypoxemia due to poor spontaneous
ventilation
Cricoid pressure
Endotracheal intubation
Indication :
- airway protection
- relief of obstruction
- mechanical ventilation & oxygen
therapy
- respiratory failure
- shock
- hyperventilation for intracranial
hypertension
- reducing work of breathing
- facilitation of suctioning/pulmonary toilet
Laryngeal Mask
Combitube
Thank you