China
Africa
Explore chapters and articles related to this topic
Primary and Secondary Surveys
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Upon initial evaluation of a trauma patient, the airway is secured first.Look for foreign bodies obstructing the airway. Be wary of facial, mandibular, tracheal or laryngeal fractures which can result in airway obstruction. Suction to clear blood and secretions. Secure the neck in a hard cervical collar. Assume that a cervical spine injury exists unless proven otherwise.Establish a definitive airway if there is any doubt about the patient's ability to maintain airway patency. This is especially true for patients with head trauma and a Glasgow Coma Scale (GCS) of 8 or lower; initially the jaw-thrust or chin-lift manoeuvre is carried out. If the patient is unconscious or has no gag reflex, an oropharyngeal airway may be temporarily placed, as arrangements are being made to intubate the patient. While intubating, the cervical collar is opened and a team member manually restricts cervical spine motion.Frequently re-evaluate airway patency. Progressive airway loss may occur in a deteriorating patient.Establish an airway surgically if intubation is contraindicated or cannot be carried out.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The oropharyngeal airway is sized from the central incisors to the angle of the jaw, with the concave side downwards. The procedure is usually tolerated in the poorly responsive patient, but the risk of inducing vomiting should be remembered and suction must be available. In children, a tongue depressor is used and it is guided in with the concave side downwards. There is no rotation, as there is in adults, in order to avoid causing damage to the soft tissues of the palate.
The primary survey
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Airway adjuncts should be used if needed and if tolerated. Care should be taken with nasopharyngeal airways in significant facial trauma, as there is a small risk of insertion through a fracture into the cranial cavity. However, there is no convincing evidence to suggest any significant risk in head injury, providing the correct insertional technique is used. If an oropharyngeal airway is placed, and tolerated, the patient is not able to protect his airway and is likely to require a definitive airway. If pre-hospital emergency anaesthesia (PHEA) is available, it should be considered as soon as possible and performed as expeditiously as is safe.
A cluster of lysergic acid diethylamide (LSD) poisonings following insufflation of a white powder sold as cocaine
Published in Clinical Toxicology, 2021
Darren M. Roberts, Kulanka H. Premachandra, Betty S. Chan, Robin Auld, Thanjira Jiranantakan, Christopher Ewers, Catherine McDonald, Vanessa Shaw, Jared A. Brown
On arrival of emergency services this individual was hypertensive (blood pressure (BP) 170/95 mmHg, pulse 80 beats/min), pupils 9 mm bilaterally, combative and delirious (Glasgow Coma Scale (GCS) fluctuating between 7/15 and 13/15) requiring physical and chemical restraints with intravenous (IV) droperidol and midazolam. Subsequently he required a Guedel’s (oropharyngeal) airway and then nasopharyngeal airway to maintain oxygenation but ventilation was maintained with a respiratory rate of 20 breaths/minute. On arrival to the emergency department his airway and breathing were unchanged with systolic blood pressure 123 mmHg and pulse 85/minute. His GCS was 6/15 with hypertonia, hyperreflexia, inducible sustained ankle clonus, and pupils 7 mm in diameter bilaterally and minimally reactive. He was hypothermic (32.5 °C). Twenty minutes after presentation his GCS decreased further, repetitive movements of his lips and tongue were observed, and his respiratory rate increased to 25 breaths/min which prompted intubation for airway protection. Other treatment included active warming, midazolam infusion for sedation, levetiracetam 1 g twice daily to cover possible seizure activity, and admission to the intensive care unit. Investigations including a non-contrast computed tomography (CT) scan of his brain, chest X-ray, routine blood tests including a venous blood gas were largely unremarkable. A rapid urine drug screen (Cedia, Thermo Scientific) was positive for cannabis and benzodiazepines (attributed to the midazolam) and negative for opioids, amphetamines, antidepressants, barbiturates, cocaine and alcohol.
Correlation of palatal volume with nasopharyngeal volume on computed tomography scans of an Iranian subpopulation
Published in Orthodontic Waves, 2020
Ali Moshajari, Azin Irannezhad, Zahra Dalili Kajan, Navid Karimi Nasab, Elahe Rafiei, Pejman Kiani
In the present study, no significant correlation was noted between the palatal volume and nasopharyngeal volume. Search of the literature by the authors yielded no study on the correlation of palatal volume and nasopharyngeal volume. Thus, the present study seems to be the first to quantitatively assess the correlation of palatal volume and nasopharyngeal volume using CT. Therefore, herein, we discuss the correlation between palatal expansion and airway volume. Almuzian et al. [17] demonstrated expansion of the nasopharynx and its increased volume following palatal expansion. Smith et al. [18] showed a significant increase in nasal and nasopharyngeal volume after palatal expansion. In contrast, Ribeiro et al. [19] observed no significant change in nasopharyngeal volume. However, the change in oropharyngeal airway volume was significant. Zhao et al. [20] found no significant difference in nasopharyngeal and oropharyngeal volume. Usumez et al. [21] observed an increase in nasopharyngeal airway dimensions, although this increase was not significant. In the examined area of airways (nasopharynx) in our study, there was no correlation between palatal volume and airway volume. Thus, the comparative studies in other airway areas (oropharynx or hypopharynx) and/or the total airway volume with palatal volume might be helpful to find a potential correlation which can be considered for future studies.
Prehospital Pediatric Respiratory Distress and Airway Management Training and Education: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John Lyng, Matthew Harris, Maria Mandt, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
In addition to nasopharyngeal issues, younger pediatric patients and patients with various congenital diagnoses may have larger tongues, smaller jaws, larger occiputs, and increased secretions that may also impede airway patency (5). Further, children often present with stridor due to anatomic subglottic narrowing and smaller diameter of the trachea. Multiple diagnoses can lead to stridor including infectious processes, congenital malformations, anaphylactic reactions, or foreign body obstruction. Education on airway positioning, jaw thrusting, suctioning, proper selection of oropharyngeal airway size and indications for use, and selection of inhaled medications appropriate for treatment of stridor are recommended.