Airway Management

PHTLS Lecture Notes

These notes are designed to be used to accompany the standard PHTLS slides for the 30 minute Airway Management and Ventilation course.
The time under each section title is the time at which that section should be starting

Introduction

0:00
Slide: Review objectives [4.2]
Take from slide
Slide: Know what you need to manage airways properly [4.3]
Explain why each key or tool needed

Anatomy

2:00
Slide: Anatomy of upper airway [4.4]
Define border with lower a/w (trachea)
Relate noise to degree of obstruction
Slide: Anatomy of lower airway [4.5]
Recap flow of air in, exchange process, flow of air out
Note potentials for damage / obstruction

Physiology

5:00
Slide: Respiratory System [4.6]
Note standard trigger of respiration by high CO2 levels
Slide: Hypoxia [4.7]
Quick explanation of aerobic / anaerobic mechanism

Scenario 1

8:00
Slide: Football player still down after hard block [4.8]
Take suggestions from class for injuries given mechanism
Slide: Findings [4.9]
Note our A-E approach. Talk down list. Ask for suggestions of treatment along with reasons why.
Slide: Manual airway control [4.10]
Describe trauma jaw thrust and chin lift. Note that as we do this, player wakes up

Scenario 2

11:00
Slide: Motorcycle-car collison [4.11]
Note helmet damage and implications, quick discussion on when to remove helmets.
Slide: Findings [4.12]
Go through A-E and ask for probable causes. At end, summarise and ask for suggestions of life-threats
Slide: Discussion of injuries[4.13]
Look at mechanism, respiratory noise, resp rate and cyanosis, low LOC and their implications

Mechanical Methods -- Basic

15:00
Slide: List of devices [4.15]
Show list, ask for suggestions for motorcyclist. Still conscious, so OPA probably best.
Slide: Suctioning [4.16]
Describe suction techniques and kit (large bore rigid tubes). Note stimulation of vagus nerve that can occur.
Slide: OP airway [4.17]
A good adjunct, doesn't protect trachea, intact gag reflex contraindicates it.
Slide: NP airway [4.18]
Better tolerated, but dangerous for head injuries as can stimulate vagus nerve or even enter brain (if fractured base of skull)
Slide: Multi-lumen airways [4.19]
Not in widespread use, though NJ military medics use. Quite good at securing airway and simpler than intubation
Slide: Laryngeal mask [4.20]
Not used in USA, being contemplated in UK. Would be good for this motorcyclist.

Mechanical Methods -- Advanced

19:00
Slide: Intubation with in-line stabilisation [4.21]
The way to go, but difficult
Slide: Indications and techniques for this [4.22]
Note skill station to come. C-spine compromise indicates in-line approach -- harder than normal.
Slide: Nasotracheal intubation [4.23]
Good when the mouth is blocked or when an intact gag reflex. Blind NTI needs patient to be breathing to ensure proper placement, and is contraindicated by fractures around intubation area.
Slide: Transtracheal ventilation [4.24]
Indicate approach
Slide: Indications for TTV [4.25]
Generally a last resort, big problem is CO2 retention, doesn't isolate trachea

Managing The Airway

22:00
Slide: Adequate maintenance [4.26]
Note need to keep constant eye on airway in patients with lowered LOC and ensure that devices are placed and maintained properly
Slide: Oxygen [4.27]
"Trauma patients are dying for oxygen". Emphasise and explain need for delivery of hi-con oxygen in trauma.
Slide: Pitfalls of oxygenation [4.28]
Don't just look at fraction of O2 supplied, patient needs volume getting to their alveoli.

Volume and Rate

24:00
Slide: Lung volumes [4.29]
Take from slide. Define tidal volume, dead space, minute volume
Slide: Minute volume [4.30]
Show how rapid shallow breathing ain't enough
Slide: Minute volume rates [4.31]
Define resp rate lower than 10-12 or higher than 28-30 as needing assistance -- note how we assist (BVM)

Scenario 3

26:00
Slide: Skier scenario [4.32]
Read scenario, ask for injury suggestions from mechanism
Slide: Findings [4.33]
Go through A-E. Discuss minute volume of patient, cause of injury and action

Ventilation

28:00
Slide: Purpose of ventilation and devices [4.34]
Skip through
Slide: BVM [4.35]
Workhorse of EMS: 100% O2 possible, but needs 2-3 people
Slide: O2-powered demand valve [4.36]
Neat idea, reduces people needed, but hard to tune for a casualty and prone to gastric distension
Slide: Transport ventilators [4.37]
Specialised and expensive, very neat, but can we afford them?

Summary

29:00

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