Airway management

In cases triaged as requiring immediate treatment, the airway must be secured immediately if the patient is unconscious and has signs of airway obstruction. Simple measures such as tilting the head and lifting the chin and placing the patient in the left lateral position can be used in pre-hospital care in both the hot and warm 

Airway intubation if the Glasgow Coma Scale (GCS) is less than 8. Use of the laryngeal mask airway (LMA) when working in personal protective equipment (PPE). 

Continue ventilation using a PGPV with a demand function (to adapt to partial respiratory failure) at 12/min and Vt = 500 mL for a 70 kg person. Ventilation should be at an Fi02 of 1 initially reducing to 0.5 as soon as adequate oxygenation is demonstrated clinically and by pulse oximetry. 

Early toxic respiratory failure will usually be type 2 (low PaOa and high PaCOa) and adequate ventilation will reverse this situation quickly. If end-tidal CO2 monitoring is available, this will be a valuable indicator of ventilation effectiveness 

Note that airway and ventilation must take priority over antidote measures when respiratory failure is present, with the exception of acute cyanide poisoning. 

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Prompt stabilization and aggressive fluid resuscitation of patients with active bleeding are followed by endoscopic examination. Airway management is critical. 

Antifreeze (ethylene N, V, AMS, lethargy metabolic Airway management key Fomepizole, ethanol. 

In patients who are at risk from the abrupt onset of seizures or mental status depression, activated charcoal should be administered by medical or paramedical persormel capable of airway management to prevent aspiration in the event of spontaneous emesis (POISINDEX, 2007 Ellenhom et al, 2002). 

Apnea occurred after the intramuscular injection of ketamine 4 mg/kg to sedate a healthy 4-year-old boy (16). This case illustrates the need for adequate monitoring and preparation for emergency airway management when using ketamine for sedation. 

In the intensive care unit muscle relaxants are used to facilitate airway management and mechanical ventilation. The duration of administration can range from a single dose to continuous infusions for up to several weeks. Patients in ICU are more hkely to have abnormalities of acid-base balance, electroljrte balance, body temperature, and liver and kidney function, predisposing them to the adverse effects of neuromuscular blocking drugs. 

HPI CS is a 5 -year-old man admitted for an anterior Ml. Three days after admission, the patient s nurse found him unresponsive. His vital signs included no detectable blood pressure or pulse. ECG showed VT that progressed to ventricular fibrillation (VF). Immediate electrical defibrillation was applied. Other treatments instituted include airway management, chest compression, and establishment of IV access. After three shocks, 1 mg epinephrine was given and patient was shocked again. However, he was still in VF and amiodarone was administered. 

Supportive care, including airway management as well as cardiac and blood pressure monitoring. 

Airway management, respiratory support, and high-flow oxygen are indicated for the cyanotic patient. The cardiovascular, neurological, and metabolic... 

No antidote is available. Tetrodotoxin is adsorbed by activated charcoal. Treatment is symptomatic and supportive with special attention to airway management and cardiac support. 

Airway - the airway of the casualty must be maintained at all times. In the unconscious casualty, this may involve simple basic airway manoeuvres plus suction of the copious secretions associated with chemical poisoning. Occasionally, there may be a requirement for advanced airway management, such as tracheal intubation, to protect the airway from the excessive secretions and to prevent aspiration of regurgitated stomach contents. 

Airway management key due to risk of aspiration, determine blood glucose level... 

Clancy M, Nolan J Airway management in the emergency department. Emerg Med J 2002 19(1) 2-3. [PMID 11777859] (Review.)... 

In a publication by Reeves et al. (2004) reported that conscious sedation using propofol actually amounted to deep sedation. The use of this medicine should therefore be restricted to personnel trained in anaesthesia and airway management. 

Personnel in the appropriate protective clothing (usually Level A or B) should find those persons who are alive but not ambulatory. The rescuers should remove them from the scene using a long backboard or other improvised stretcher. Only lifesaving medical treatment (airway management, bleeding control, and use of NAAK) is performed at this time. Victims who are unresponsive with no pulse should be left on-scene at this time. 

Toxicity management of mild to moderate toxicity usually requires only supportive care. Management of severe toxicity may require more aggressive intervention. Monitor the need for airway management, including endotracheal intubation in patients with CNS depression or recurrent seizures. Treat seizures with IV benzodiazepines and barbiturates. Treat hypotension with fluids and vasopressors. Atropine maybe used to treat hypotension associated with bradycardia. 

Table 3.3. Essential airway management equipment. Modified from [40], p. 6, with permission...

Santucci RA, Wessells H et al. (2004) Evaluation and management of renal injuries consensus statement of the renal trauma subcommittee. BJU Int 93 937-954 American College of Surgeons (1997) Advanced trauma life support manual, 6th edn. ACS, Chicago Kaur S, Heard SO (1996) Airway management and endotracheal intubation. In Rippe JM, Irwin RS, Fink MP, Cera FB (eds) Intensive care medicine, vol 1. Little Brown, New York, pp 1-15... 

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