So here is some thoughts around the questions.
Airway management and ventilatory support is fundamental for treating all critically ill and injured patients.
We must be good at assessing the level of compromise. It defines the rest of the patient management at all levels and the bad management will result in … yes real badness very quickly.
DO NOT skip the initial look and listen after correct positioning (head tilt/chin lift, jaw thrust or the sniffing position).
* Dr. Ellis would like to see the sniffing position to be known more widely and used earlier in the airway management. We will talk more on the next post.
In unconscious patients, gag reflex used to be taught as an ability to maintain airway but is no longer recommended for the obvious reason. Well who would try gagging sick patients anyway???
Instead, looking at the back of throat (if unconscious) for inability to swallow (having pool of saliva, blood etc) is a good indicator for the patient unable to maintain airway.
3 things to look for when assessing obstructive airway compromise are;
- Hot potato voice…what a ?? or muffled sound voice
- Inability to swallow
- Stridor (imminent)
Along with airway, the initial look, such as skin colour, ALOC, chest movement etc, will give you some clues for the ventilatory compromise, but here is an additional assessment tool taught by Dr. Ellis.
- GCS < 10
- SPO2 < 90%
- Respiratory rate <8 or >30
- ETCO2 > 45
Airway vs ventilation
This is just a quick reminder that, although synergistic and taught together, airway and ventilation are two totally separate entities and they are not synonymous. Poor airway will more than likely compromise ventilation but not always, and bad ventilation will probably result in positive O sign despite having good airway.
Catch you again next week!