ATLS
Laryngeal fracture triad - ANS Hoarseness, subcutaneous, emphysema, palpable fracture
Signs of airway obstruction - ANS Agitation, obtunded, cyanosis indicates hypoxemia, so I
inspect the nail beds and Sercombe oral skin. Look for retractions and use of accessory
muscles. Pulse ox.
Listen for abnormal sounds, noisy breathing is obstructed, breathing Dash snoring, gurgling and
crowding sounds or strider can be associated with partial occlusion of the pharynx or larynx.
Hoarseness or dysphonia implies functional laryngeal obstruction.
Ways ventilation can be compromised - ANS Airway obstruction
Altered Ventilatory mechanics.
Central nervous system depression.
Injuries below C3 level result in - ANS Maintenance of the diaphragmatic function, but loss of
the intercostal and abdominal muscle contribution to respiration.
These patients display a seesaw pattern of breathing in which the abdomen is pushed out with
inspiration while the lower rib cage is pulled in. - abdominal breathing or diaphragmatic
breathing- resulting in rapid shallow breaths that can lead to atelectasis and ventilation
perfusion mismatch ultimately respiratory failure
Signs of an adequate ventilation - ANS Look for symmetric rise and fall the chest,
adequate chest wall, excursion,
asymmetry,
labored, breathing,
equal movement of air on both sides of the chest,
decreased or absent breath sounds over one or both hemi thoraces,
tachypnea,
pulse oximeter (does not measure adequacy of ventilation)
Use capnography and spontaneously, breathing and intubated patients to assess whether
ventilation is adequate
Mnemonic for assessing potential for a difficult intubation - ANS Lemon
Look externally.
Evaluate 3-3-2 Rule.
Mallampati
Obstruction.
Neck mobility.
, How to insert oral airway - ANS Insert the oral airway upside down, with a curved part directed
upward, until it touches a soft palate.
Then rotate the device 180°, so the curve faces downward and slip it into place over the tongue.
Don't use this method in kids - in kids use a tongue blade to depress the tongue and then insert
with its curbside down, be careful not to push the tongue backward
Three types of definitive airways - ANS Or a tracheal tube
Nasal tracheal tube
And surgical airway - cricothyrotomy and tracheostomy
Criteria for establishing a definitive airway clinical findings - ANS A - inability to maintain a
patent airway by other means within pending potential airway compromise
B- inability to maintain adequate oxygenation by facemask or presence of apnea.
C -, obtundation or combativeness resulting from cerebral hyperperfusion.
D - obtundation, indicating the presence of head injury, GCS of eight or less, sustained, seizure
activity, and the need to protect the lower airway from aspiration of blood or vomitus.
What GCS score requires prompt intubation - ANS 8 or less
Relative contraindication to nasal tracheal intubation - ANS Facial, frontal, sinus, basilar skull,
cribriform plate fractures
Evidence of nasal fracture, raccoon, eyes, battle sign, CSF leak - rhinorrhea or otorrhea
Cricoid pressure reduces the risk of - ANS Aspiration
When cricoid pressure reduces the view of the larynx, what should you do? - ANS Apply
backward upward and right word pressure, burp on the thyroid cartilage
When you can't visualize the vocal cords, what can you use? - ANS Gum elastic bougie
When is drug assisted intubation indicated - ANS When patients need airway control, but have
intact, gag reflex, especially in those who have sustained head injury
Name an induction drug - ANS Etomidate 0.3 mg/kg - does not negatively affect blood pressure
or intracranial pressure, can depress adrenal function
Neuromuscular blocking agent common - ANS Succinylcholine 1 mg per kilogram usual dose is
100 mg can do 1 to 2 mg per kilogram
- Rapid onset of paralysis, less than one minute and duration of five minutes or less
- risk of hyperkalemia, so huge cautiously in patients with severe crush injuries, major burns,
electrical injuries
- Extreme caution with pre-existing, chronic renal failure, chronic paralysis, chronic
neuromuscular disease