WMN Editors

AIRWAY PART III – ADVANCED AIRWAY ADJUNCTS

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ISSN-1059-6518

Part III of the Airway Series – Advanced Airway Adjuncts

By Frank Hubbell, DO

 Illustrations by T.B.R. Walsh

 In this section we will discuss the use of the endotracheal tube and the remaining airway adjuncts.

 Endotracheal Intubation (ETT)

 Gum Elastic Bougie/Flex-Guide Tube Introducers

 Digital Intubation

 Nasopharyngeal Intubation

 Suction

 Pulse Oximetry

 Capnography and End-Tidal CO₂ detectors (EtCO₂)

 CPAP

 Stoma and Tracheostomy Care

TOTAL AIRWAY CONTROL – Endotracheal Intubation:

Last, but not least, of the airway adjuncts is endotracheal tube (ETT) intubation.

This is the most advanced airway, and it provides the greatest protection for the airway. This airway technique requires the most knowledge of airway anatomy and many hours of practice to develop the skills of using it. This is also a classic example of a, “use it or lose it” skill, requiring frequent live ETT intubations or practice on airway manikins.

ENDOTRACHEAL TUBE INTUBATION: (ETT)

 

Indications:

Respiratory or cardiac arrest

Unconscious without a gag reflex

Rapidly deteriorating respirations or impending respiratory failure

Glottis seen through laryngoscopy

Glottis seen through laryngoscopy

Significant risk of aspiration from vomiting and obtundation

Potential airway obstruction from trauma, burns, or anaphylaxis

 Contraindications:

Epiglottitis (patient is sitting up, in the sniff position, and drooling).

Head, neck, or facial trauma that prevents visualization of the airway anatomy.

Advantages of Endotracheal Intubation:

  Complete control of the airway.

Isolates the airway.

Minimizes the risk of aspiration of gastric contents.

Eliminates the need to maintain a mask seal.

Allows direct suctioning of the trachea and respiratory passages.

It permits administration of some medications via the endotracheal tube –

naloxone, atropine, vasopressin (adults), epinephrine, and lidocaine.

 

Disadvantages of endotracheal intubation:

The techniques require considerable training and ongoing practice.

Intubation requires specific equipment.

Typically it is necessary to directly visualize the vocal cords.

Intubation bypasses the upper airway, and its functions of cleaning, warming, and

 humidifying the air en route to the alveoli.

Complications of endotracheal intubation:

Risk of equipment malfunction

Soft tissue damage

Broken teeth

Esophageal intubation

Tension pneumothorax

Endobronchial intubation (tube advanced too far into the right or left mainstem bronchus)

Breath sounds present on one side of the chest, diminished on the other side.

 Resistance to ventilations with a bag-valve-mask (BVM).

Pallor, cyanosis, evidence of hypoxia.

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WMN Editors

AIRWAY PART II: EMERGENCY AIRWAY MANAGEMENT

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ISSN-1059-6518

AIRWAY-PART II – EMERGENCY AIRWAY MANAGEMENT

By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

The PURPOSE of Airway Adjuncts:

 

The purpose of airway adjuncts is to maintain a patent, open airway. This is accomplished primarily by preventing the tongue or other soft tissues from occluding the entrance to the airway at the larynx.

 

These airway adjuncts are divided into three categories.

1.     There are primary airways for immediate support of the airway

2.     Intermediate airways designed for longer-term use.

3.     Total airway control airways, which require endotracheal intubation that not only maintain an open, patent airway, but also help to prevent aspiration of fluids into the lungs.

 

REMEMBER: Primary and intermediate airway adjuncts do not necessarily prevent the aspiration of saliva, blood, vomitus, or other fluids from getting into the trachea and lungs.

 

IMMEDIATE TECHNIQUES for ESTABLISHING and  MAINTAINING an OPEN AIRWAY:

 

PRIMARY AIRWAYS:

 

The RECOVERY POSITION:            recovery-position

 

This is the quickest and simplest way to establish and maintain an open airway in an unconscious patient. You simply have to know how to properly safely logroll someone onto his or her side.

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WMN Editors

Mild TRAUMATIC BRAIN INJURY (mTBI) – CONCUSSIONS

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ISSN-1059-6518 Volume 25 Number 6

Mild TRAUMATIC BRAIN INJURY (mTBI) – CONCUSSIONS

 By Frank Hubbell, DO

 

For years we rode our bicycles without helmets, played touch or flag football without helmets or padding, climbed, paddled, skied and did all sorts of sports without worrying about a little bump on the head. But, it would appear that modern medicine, moms, and coaches have uncovered some potentially major problems associated with a simple head injury known as a concussion.

 

Any bump or blow the head that damages the brain is referred to as a traumatic brain injury (TBI). A TBI is an injury to the brain that disrupts of the brain’s normal functioning . TBI is referred to as mild if the loss of consciousness or changes in level of consciousness are brief. TBI is considered severe if the changes or loss of consciousness are extended.

 

Traumatic Brain Injury Stats:

 

There are 1,700,000 TBIs per year in the USA.

75% of TBIs are concussions or other forms of mild TBI.

Causes of TBI:

Falls – 35.2%

Motor Vehicle Accidents – 17.3% (largest % of deaths – 31.8%)

Struck by/Against – 16.5% (largest cause of TBI in children – 25%)

Assault – 10%

Unknown/other – 21%

Helmets and TBI:

90% of fatal bicycle accident victims were NOT wearing a helmet.

Motorcycle accidents – greater chance of severe TBI and death if the driver or passenger were NOT wearing a helmet.

Sports:

21% of TBI are sports-related in children and teenagers.

#1 cause of sports-related death.

85% of head injuries (TBI) are prevented by helmets.

A concussion is the most common form of TBI. A concussion occurs when the brain has suffered a biomechanical injury, a direct force has been applied to the head, causing functional rather than structural changes of the brain, in other words a disruption of normal functioning of the brain. What this simply means is that the individual has the symptoms of a head injury, but all diagnostic imaging, xrays, MRIs, and CTs of the head are normal. The insult to the brain is on a physiological, cellular level, rather than creating gross anatomical changes.

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WMN Editors

LION ATTACK IN ZIMBABWE

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May/June 2010  ISSN-1059-6518  Volume 23 Number 3

Lion Attack in Zimbabwe

By Rob Nixon

Our man in Africa, Rowan Lewis, sent us this eyewitness account of a lion attack in the Tashinga National Park, Zimbabwe. Rowan managed to get permision for us to reprint it from Turbo Charge, the tour group that ran the safari, and the account was first published in their newsletter. It has since appeared in the blog “Zimbabwe Lifestyle”. Read more