Why is airway a priority

Identify evidence of upper airway obstruction. Prolapse of the tongue and accumulation of secretions, blood, or vomitus are common causes of obstruction.

Signs may include wheezing, sonorous respirations, stridor, cough, and dysphonia. Upper airway obstruction should be removed if present. Back blows or the Heimlich maneuver may clear the obstruction. If not, use suction or direct visualization and a Magill forceps or finger. Blind finger sweep is contraindicated. Obstructions that recur or persist require endotracheal intubation, either orotracheally or via cricothyroidotomy, tracheostomy, or percutaneous transtracheal jet ventilation PTTJV see also Chapters Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'.

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Posted by Sam D. Drug overdoses, sudden injuries, respiratory issues, and myriad other health concerns can trigger cardiac arrest. Cardiac arrest is a leading cause of death, but many of these deaths are preventable. Every year, more than , cardiac arrests occur outside of hospitals. Nearly half of cardiac arrest victims survive when bystanders administer CPR.

The figure is even higher when trained first responders are prepared to perform CPR while managing the airway. Airway management is key to successful CPR, and first responders must have the right equipment ready to go.

Cardiac arrest can occur for many reasons, including airway obstructions. Moreover, drug overdoses and a handful of other medical emergencies can cause vomiting that quickly leads to aspiration, further complicating cardiac arrest. The right suction machine can promptly clear the airway. Bystanders performing CPR are instructed to perform mouth-to-mouth resuscitation.

Although this strategy can work, oxygenating the patient is the gold standard in cardiac resuscitation. PLoS Med. Swain SA, Stiff G. Issues and challenges for research in major trauma. Emerg Med J. The success of emergency endotracheal intubation in trauma patients: a year experience at a major adult trauma referral center.

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Mechanical complications and outcomes following invasive emergency procedures in severely injured trauma patients. Nat Sci Rep. Emergency tracheal intubation immediately following traumatic injury: Eastern Association for the Surgery of Trauma practice management guideline.

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Journal Trauma Acute Care Surg. Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma research and Education Foundation of san Diego.

Arch Surg. Decreased mortality after prehospital interventions in severely injured trauma patients. Survival benefit of physician-staffed helicopter emergency medical services HEMS assistance for severely injured patients. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.

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Does advanced airway management improve outcomes in adult out-of-hospital cardiac arrest? Ann Emerg Med. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.

JAMA ;— Effect of a strategy of a Supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial.

Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial.

Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest: a randomized clinical trial. JAMA; 8 — Cerebral blood flow and metabolism following ketamine administration.

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Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anaes Analg. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study.

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Acad Emerg Med. Video laryngoscopy does not improve the intubation outcomes in emergency and critical patients — a systematic review and meta-analysis of randomized controlled trials. Video laryngoscopy vs direct laryngoscopy on successful first-pass Orotracheal intubation among ICU patients. Guidelines for the management of tracheal intubation in critically ill adults. Scandinavian SSAI clinical practice guideline on pre-hospital airway management. European resuscitation council guidelines for resuscitation section 4.

Cardiac arrest in special circumstances. AAGBI: safer pre-hospital anaesthesia The role of the anaesthesiologist in air ambulance medicine. Curr Opin Anaesthesiol. At RCH the availability of micro-cuffed ETT, and the advantage of more completely protecting the airway with the use of these ETT's makes them the first choice when intubating children who have been severely injured. Introducer: For ET tubes 4. Oral: Always use oral, never nasal, intubation in a child with a head injury because of the risk of meningitis, or of entering the cranial cavity if an undiagnosed fracture of the skull base is present.

There may be a delay between administration of the anaesthetic agent and muscle relaxant at the discretion of the team lead for example to optimise oxygenation through titrated dose of anaesthetic agent. Prioritise avoidance of hypoxia at all times.

Continue gentle positive pressure ventilation with positive end- expiratory pressure during the apnoeic period. Never use a nasogastric tube or a nasotracheal tube in a child with a head injury because of the risk of meningitis or of entering the cranial cavity where there is undiagnosed fracture of skull base.

If not, re-position the tube and re-tape.