13.2 Airway Management and Chest Trauma Flashcards
ET Tubes
- Short term use (orotracheal or nasotracheal)
- Pass through vocal cords
- Inflated cuff prevents air from leaking around the tube when on the ventilator and holds the tube in place.
- PATIENTS CANNOT EAT OR SPEAK WHEN ON ET TUBE
Complications
- Discomfort
- Risk of self-extubation (pulling out)
- Damage to teeth/vocal cords
- Aspiration of teeth or laryngoscope bulb during insertion
- Esophageal or main bronchus intubation (assess bilateral breath sounds and chest x-ray)
- Sinusitis from nasotracheal tube
- Occlusion of endotracheal tube due to biting (use bite block to prevent this)
Laryngeal Mask Airways and Tubes
- LMA’s (Laryngeal Mask Airways)
- Alternative to ET without high levels of risk.
Benefits
- Cause less gastric distention
- Less likely for aspiration
- Great for short term airway and easier to use than ET tube
- Laryngeal Tube (King LT)
- Inserted blindly through oropharynx into hypopharynx to create airway during anesthesia or cardiopulmonary resuscitation. Easier to use than ET tubes.
Cricothyroidotomy (Cric)
- Emergency airway puncture through skin during life-threatening conditions such as airway obstruction, angioedema, or massive facial trauma.
- Last resort when ET tube is impossible or contraindicated.
- Easier than tracheostomy and fewer complications (does not require manipulation of cervical spine)
- TEMPORARY MEASURE
STEPS
A - Vertical then horizontal incision through cricothyroid tissue
B - Dilator used to spread and enlarge the opening
C - Tube with obturator inserted until tube lies against skin
D - Obturator and dilator are removed, inner cannula is replaced, and cuff is inflated.
Cricoid Pressure
- Used in anesthesia to prevent aspiration from potential regurgitation of stomach contents in at risk patients.
- Used when full stomach is at risk during surgery, obese patients, and GERD.
- Fingers are used to occlude the esophagus until ET intubation is confirmed.
- Started prior to anesthesia, and then finished when ET tube is secured.
Hemorrhage
Signs of Internal Bleeding
- Increased HR
- Decreased BP
- Bruising/discoloration/swelling/sweating
External Hemorrhage
- Pressure directly over injury or pressure point compression over artery supplying the area.
- Maintain pressure until area is treated.
Limb Hemorrhage
- Tourniquet is placed 2-3 inches above source of bleeding.
- If it is not tight enough it can actually increase bleeding.
- Fluid replacement is also very important. Start with crystalloid (NaCl) then colloid (albumin)
Wounds
- Wounds are cleansed and debrided if indicated.
- Tetanus prophylaxis
Trauma
Forensic Evidence Documentation
- Description of all wounds
- Mechanism of injury
- Time of event
Education
- Information about maintaining home safety and preventing violence
- AVOID using the word ACCIDENT. It is preventable so we should use the word “fate” or “happenstance”
- Provide responsibility and accountability to prevent recidivism (repeated trauma)
Priority of Care for Trauma
Multiple Trauma
- 1 event that causes life-threatening injuries to at least 2 organs or organ systems.
Single Trauma
- Still receive full assessment because they may be more severe then they appear.
Immediately After Trauma Body is..
- Hypermetabolic
- Hypercoagulable
- Severely Stressed
Order of Care for Trauma
1 - Airway
2 - Hemorrhage
3 - Hypovolemic Shock
4 - Assess head/neck
5 - Evaluate for other injuries
6 - Splint fracture and neuro exam
7 - Preform more thorough examination and diagnostics.
Chest Trauma
- Symptoms are general and vague so it is difficult to identify extent of damage
- Most common cause is motor vehicle accidents
- They can cause hypoxemia (disruption of airway), hemorrhage, collapsed lung, and pneumothorax, hypovolemia, etc.
- Can also lead to AKI and hypovolemic shock.
Blunt Chest Trauma
Assessment
- Time since injury
- How did it happen
- Level of responsiveness
- Estimated blood loss
- Alcohol/Drug use
- Pre-hospital treatment
Primary Assessment
- Airway obstruction
- Pneumothorax
- Flail chest
- Cardiac tamponade
Secondary Assessment
- Chest x-rays
- CBC
- Clotting
- O2 sat
- ABG
- ECG
Management
- Immediate airway establishment
- Fluid management
- Drain intrapleural fluid
- Occlude any openings into the chest (open pneumothorax)
Pneumothorax
- Presence of gas in pleural cavity which causes lung collapse.
- Caused by rupture in chest wall.
- Rupture in lung is a one-way valve that lets air in on inspiration but does not let air out on expiration.
- Presence of air in the pleural cavity destroys the negative pressure of pleural space which disrupts the equilibrium between elastic recoil forces of lung and chest wall.
- AIR CANNOT ESCAPE CAUSING PRESSURE ON HEART AND OTHER LUNG
- SEVERE DYSPNEA
- TRACHEAL DEVIATION
Hemothorax
- Presence of blood in pleural space
- Caused by trauma, lung cancer, anticoagulation
Hemopneumothorax
- Blood and air in pleural space
- Caused by trauma or thoracic surgery
Pleural Effusion
- Water (serous fluid) trapped in pleural space
- Caused by heart failure, renal failure, lung cancer.
