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Airway management
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The use of an NPA is recommended in the semi-conscious casualty as once in situ it is well tolerated and unlikely to cause gagging. There is a frequently expressed concern that any suspicion of a base of skull fracture is a contraindication to use of a nasopharyngeal airway. This is based upon very limited evidence involving two individual case reports (14,15) in which an NPA penetrated the skull vault through a base of skull fracture and has resulted in many patients being denied appropriate airway management. Current guidance (16) suggests that the risks from misplacement of an NPA are outweighed by the both the potential benefit in airway compromise and by the risk of vomiting caused by use of an oropharyngeal airway in the semi-conscious patient.
Anesthesia for pediatric trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
The goals of airway management in the pediatric trauma patient include achieving adequate oxygenation and ventilation along with protection of the patient’s airway reflexes. The first priority within the Primary Survey is to evaluate and maintain the integrity of the airway. If the patient’s condition permits, a comprehensive airway evaluation should be performed. In the conscious child, the ability to vocalize is reassuring and may suggest a patent airway. In the unconscious child, the airway must be assessed quickly to confirm if breathing is present. If the patient has an obstructed airway, performing a jaw-thrust maneuver may reduce or eliminate the airway obstruction [14]. An oropharyngeal airway may also be considered to temporarily maintain upper airway patency until a definitive airway has been established. A nasopharyngeal airway should be used with caution particularly if midfacial injuries are suspected. Suctioning should also be considered if secretions are present. Verifying that airway obstruction is not related to inappropriate placement of the cervical collar is also indicated.
Practice Paper 9: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
This patient has upper airway obstruction in association with a Glasgow Coma Scale score of 12/15. He is therefore unlikely to tolerate an oropharyngeal airway, for the reasons described above. A nasopharyngeal airway is a flexible plastic tube that is inserted into the nostril and passed into the pharynx, where it maintains the patency of the airway. It is usually inserted into the right nostril with the aid of a lubricating jelly. The phalange at the nostril end is fitted with a safety pin to prevent the airway from being inhaled. Nasopharyngeal airways are also indicated in patients with significant maxillofacial injuries and other conditions that prevent adequate mouth opening. They are often better tolerated than oropharyngeal airways, but are contraindicated when a basal skull fracture is suspected, because of the theoretical possibility of the airway passing through the fracture into the brain.
Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS)
Published in Prehospital Emergency Care, 2022
Sattha Riyapan, Jirayu Chantanakomes, Bongkot Somboonkul, Sang Do Shin, Wen-Chu Chiang
The primary outcome of this study was survival in the ED compared between the nighttime and daytime groups. Survival in the ED was defined from ED disposition status as RTI patients survived to discharge from ED, survived to refer to another hospital, or survived to admit to inpatient. Survival to discharge was extracted from the hospital discharge status, which included the patients who were treated in the hospital and then discharged or transferred to another healthcare facility. We also compared prehospital interventions, including basic airway management, advanced airway management, oxygen supplementation, and total immobilization. Basic airway management included oropharyngeal or nasopharyngeal airway insertion. Advanced airway management consisted of endotracheal intubation or supraglottic airway insertion. Oxygen supplementation comprised nasal canula, face mask, or bag valve mask ventilation. Total immobilization included C-spine or spinal immobilization, femur traction or immobilization, and bandaging at an active bleeding area. The study identified characteristics of RTI patients at night. Alcohol use and substance abuse data was from both biologic evidence and physician’s report. Low- and middle-income countries were grouped according to the World Bank, such as Thailand, Vietnam, India, and Malaysia (see https://data.worldbank.org/income-level/low-and-middle-income).
Case report: neuroimaging analysis of pediatric ADHD-related symptoms secondary to hypoxic brain injury
Published in Brain Injury, 2019
In mid-2006, a 2-year-old boy wandered from the supervision of a daycare facility where a car window left ajar caught his attention. The crevice created by the opened car window allowed enough clearance for the patient to insert his head where he was found dangling from the neck. Bystanders found patient HR suffocated, removed him from the car window, and performed CPR. EMS personnel later arrived on scene notating his apneic and unresponsive condition and initiated treatment and transport. The patient resumed spontaneous breathing of 6 respirations per minute after being provided 6–8 ventilations through a bag valve mask. A nasopharyngeal airway was administered for the patient and BVM ventilations continued. Initial assessment of the patient presented with a decreased oxygen saturation, clenched teeth that interfered with the administration of an oropharyngeal airway, and a more dilated right pupil with more delayed reactivity to light than the left pupil. General physical assessment presented with ‘rash type’ trauma marks on the anterior neck of the patient. Other areas of patient assessment performed by EMS were within normal/functional limits and breathing stabilized to normal ranges by admission at the appropriate facility. Also noted when admitted into the ER was the patient’s decorticate posturing.
Nasal fiberoptic intubation with and without split nasopharyngeal airway: Time to view the larynx & intubate
Published in Egyptian Journal of Anaesthesia, 2018
Ahmed A. Mohamed El-Tawansy, Osama A. Nofal, Akmal Abd Elsamad, Hala A. El-Attar
Seven cases (out of 34 cases) required jaw thrust in NP group means that the assumed appropriate NP airway length (size) was not actually appropriate i.e. not passing the pharynx to get its tip just in front of the larynx to view the laryngeal inlet once FOB tip pass the NP airway tip. Actually, we are in need of Naso-laryngeal and not nasopharyngeal airway as FOB nasal intubation aid. Nasopharyngeal airway is originally designed to keep airway patent by passing the relaxed redundant collapsible pharyngeal structure obstructing the airway. we are in need to modify (increase) its length to bypass the pharynx to end nearby the laryngeal inlet i.e. to be Naso-laryngeal and not nasopharyngeal airway achieving two targets at the same time i.e. keeping the airway patent as well as transporting (carrying) the FOB tip immediately in front of the laryngeal inlet facilitating the process of laryngeal visualization and intubation especially useful for inexpert junior staff and in hurry, much secretion and/or bloody airway situation in which direct visualization through FOB may be technically challenging [17] even with expert endoscopist.