atls via aerea

ATLSJOEL ORTEGA GORDILLOR1 TRAUMATOLOGIA Y ORTOPEDIA

Situaciones difciles .*www.reeme.arizona.edu

Situaciones como estas*www.reeme.arizona.edu

A. VIA AEREA COLUMNA CERVICALMantener proteccin adecuada de mdula espinal con fijacin de dispositivos adecuadosEvitar movimientos excesivosSospecha de columna cervical:Alteracin del estado de concienciaTrauma multisistmicoTraumatismo cerrado encima de clavcula

A. VIA AEREAPerfusin inadecuada a estructuras vitales: factor importante. Oxigeno suplementario en Tx

INTUBACION ENDOTRAQUEALASEGURAR LA VIA AEREASUMINISTRAR OXIGENO SUPLEMENTARIOAPOYO VENTILATORIOEVITAR ASPIRACION CONTENIDO GASTRICOSuccin inmediata y rotacin en bloque hacia la posicin lateral

A. VIA AEREATRAUMATISMO MAXILOFACIALFX. FACIALES: hemorragia: aumento de secreciones y cada de dientesObstruccin de va area: se presenta en posicin supina.Fx. Mandbula bilateral: prdida de soporte normal

A. VIA AEREATRAUMATISMO DEL CUELLODesplazamiento y obstruccin de va area.Ruptura de la laringe o de la trquea: va area definitivaTRAUMATISMO DE LARINGERonquera, enfisema subcutneo, fractura palpableUn intento de intubacin va area quirrgica

A. VIA AEREASIGNOS DE OBSTRUCCION AEREA:RESPUESTA VERBAL POSITIVA = VIA AEREA PERMEABLEAgitacin: hipoxiaEstupor: hipercapniaRonquidos, gorgoreo, estridor, disfona

A. VIA AEREA - MANEJOVIA AEREA DEFINITIVA: presencia en la trquea de un tubo con baln inflado, conectado a alguna forma de ventilacin asistida rica en oxgenoTres tipos: tubo orotraqueal, nasotraqueal y va area quirrgica

A. VIA AEREA - MANEJOIndicaciones:Presencia de apneaIncapacidad de mantener v.a. permeable por otros mediosProteccin de aspiracin de vmito o sangrePresencia de lesin craneoenceflica (glasgow

A. VIA AEREA - MANEJOCONTRAINDICACIONES:OROTRAQUEAL- Fractura maxilofacial severa- Hemorragia orofarngea severa, edema de glotis

NASOTRAQUEAL- Paciente en apnea- Fractura de tercio medio facial- Fractura de base de crneo

Intubacin Endotraqueal : VentajasAsla la Va Area y mantiene su permeabilidad. Reduce el riesgo de aspiracin .Permite la succin de secreciones traqueales .Asegura oxigenacin a altas concentraciones .Asegura una ruta de administracin de algunas drogas en Soporte Cardiaco Avanzado .Asegura una adecuada ventilacin con un adecuado volumen tidal para insuflar los pulmones .*www.reeme.arizona.edu

Conocimiento de la Anatoma*www.reeme.arizona.edu

FISIOLOGIA DE LA RESPIRACION.*www.reeme.arizona.edu

Saber con que Herramienta soluciono el problema ?*www.reeme.arizona.edu

La laringoscopia directa es el paso clave para identificar el problema .Debe existir un manejo individual de la va area para anticiparse al grado de dificultad y as seleccionar un mtodo alternativo .Dos escenarios :No puedo intubar, pero si puedo ventilar.No puedo intubar, y tampoco puedo ventilar

*www.reeme.arizona.edu

Triada de la Muerte en Control de Daos en la Va Area Difcil .1 ) . Hipoxemia que conduce a la Hipoxia .

2 ) . Hipercapnea .

3 ) . Acidosis .

Llevaran a la disfuncin metablica .www.reeme.arizona.edu

5-*Preparacin para la IntubacinPrepare el dispositivo de reanimacin y la mscaraAbra el oxgenoTome un estetoscopioCorte la cinta adhesiva o prepare el fijador

5-*Asistiendo la IntubacinEl (la) asistente durante el procedimiento debeAsegurarse que el equipo est preparadoCorregir la posicin, estabilizar la cabezaSuministrar oxgeno a flujo libreProveer succinEntregarle la cnula endotraqueal al reanimador que est intubandoAplicar presin en el cricoides si se le solicita

5-*Asistiendo la IntubacinEl (la) asistente durante el procedimiento debeSuministrar ventilacin con presin positiva entre los intentos de intubacinConectar la cnula endotraqueal al dispositivo de reanimacinConectar el detector de CO2Observar si el detector de CO2 cambia de colorAuscultar ruidos respiratorios y observar movimientos del traxAyudar a fijar la cnula endotraqueal

Equipo de va area*www.reeme.arizona.edu

TUBOS ENDOTRAQUEALES*www.reeme.arizona.edu

Alineamiento de los Ejes*www.reeme.arizona.edu

5-*Intubacin Endotraqueal

5-*Intubacin Endotraqueal : Siempre Sostenga el Laringoscopio con la Mano Izquierda

5-*Intubacin Endotraqueal :Paso 1: Preparando La InsercinEstabilice la cabeza Suministre oxgeno a flujo libre durante el procedimientoMidazolam 0.1mg/kg

Click on the image to play video

5-*Intubacin Endotraqueal : Paso 2: Inserte el LaringoscopioDeslice el laringoscopio sobre el lado derecho de la lenguaEmpuje la lengua hacia el lado izquierdo de la bocaAvance la hoja hasta que la punta se encuentre justamente en la base de la lengua

Maniobra de Sellick*www.reeme.arizona.edu

A. VIA AEREA - MANEJOVIA AEREA QUIRURGICA1. Cricotiroidotomia con aguja:Catter 12-14 FInsertar a travs de la membrana cricotiroideaOxigeno a 15 litros minutoConector en Y o orificio lateralInsuflacin intermitente obstruyendo con el pulgar durante 1 seg. y liberando por 4 seg.Oxigenacin adecuada por 30-35 minutos

Puncin cricotiroidea*www.reeme.arizona.edu

A. VIA AEREA - MANEJO2. Cricotiroidotoma quirrgica:Incisin en membrana cricotiroideaCnula de traqueotoma (5-7 mm)Fijacin del dispositivo

Complicaciones: aspiracin, laceracin, estenosis, hemorragia, perforacin, etc.

Tubo de Traqueotoma Fijado*www.reeme.arizona.edu

Comprobacin de la Va Area Definitiva*www.reeme.arizona.edu

Monitoreo de la Oxigenacin:Pulsioximetria*www.reeme.arizona.edu

*The anatomic landmarks that relate to intubation are labeled on the slides.

Epiglottis: a lidlike structure overhanging the entrance to the trachea

The vallecula and esophagus (anatomical parts #2 and #3) are not visible on this slide. See slide 5-14 to see the location of the vallecula and esphagus.2. Vallecula: a pouch formed by the base of the tongue and the epiglottis

3. Esophagus: the food passageway extending from the throat to the stomach

4. Cricoid: the lower portion of the cartilage of the larynx

5. Glottis: the opening of the larynx leading to the trachea, flanked by the vocal chords

6. Vocal cords: mucous membrane-covered ligaments on both sides of the glottis

7. Trachea: the windpipe or air passageway, extending from the throat to the main bronchi

8. Main bronchi: the 2 air passageways leading from the trachea to the lungs

9. Carina: where the trachea branches into the 2 main bronchi

*The anatomic landmarks that relate to intubation are labeled on the slides.

Epiglottis: a lidlike structure overhanging the entrance to the trachea

Vallecula: a pouch formed by the base of the tongue and the epiglottis

Esophagus: the food passageway extending from the throat to the stomach

4. Glottis: the opening of the larynx leading to the trachea, flanked by the vocal chords

5. Vocal cords: mucous membrane-covered ligaments on both sides of the glottis

*A resuscitation device and mask capable of providing 90% to 100% oxygen should be on hand to ventilate the newborn between intubation attempts or if intubation is unsuccessful.

The oxygen tubing should be connected to an oxygen source and be available to deliver 100% free-flow oxygen and to connect to the resuscitation device. The oxygen flow should be turned to 5 to 10 L/min.

A stethoscope is needed to check for improving heart rate then for bilateral breath sounds.

Cut a strip of adhesive tape to secure the tube to the face, or prepare an endotracheal tube holder, if used at your hospital.*During the intubation procedure, the assistant plays a very important role. The intubator should never have to look away from the babys oropharynx. The assistant needs to anticipate the intubators needs and follow directions of the intubator.

Free-flow oxygen should be provided during the procedure. If suction is needed, the assistant should hand the suction catheter to the intubator and occlude the port at the intubators request.

The endotracheal tube needs to be handled cleanly and handed to the intubator so that it does not have to be turned around prior to insertion.*The assistant monitors the heart rate by tapping it out on the bed or quietly stating the heart rate periodically. The length of time for the attempt should be timed and not go much beyond 20 seconds. The assistant should be quietly supportive during this stressful period.

If an intubation attempt is not successful, the assistant may help provide positive-pressure ventilation between attempts. (Ventilation is not possible if intubating to suction meconium.)

CO2 detection is not appropriate when intubating for the purpose of suctioning meconium from the trachea. However, when intubating to ventilate the newborn, increasing heart rate and CO2 detection are the primary methods for confirming endotracheal tube placement. A rapid increase in heart rate is indicative of effective positive-pressure ventilation. If the heart rate does not rise after intubation, use the CO2 detector as the next indicator for confirming proper placement of the endotracheal tube. If the heart rate does not rise, and CO2 is not detected after several breaths, consider removing the tube, resuming bag-and-mask ventilation, and repeating the intubation process.

Instructor Tip: Accidental extubation is more likely if one person holds the tube and another ventilates. The same person should hold the tube and ventilate. The assistant is then free to auscultate and secure the tube.*The correct position of the newborn for intubation is the same as for mask ventilation.

Place the newborn on a flat surface with the head in the midline position and the neck slightly extended. It may be helpful to place a roll under the newborns shoulders to maintain slight extension of the neck.

This sniffing position aligns the trachea for optimal viewing by allowing a straight line of sight into the glottis once the laryngoscope has been properly placed.

It is important not to hyperextend the neck, because this will raise the glottis above the line of sight and narrow the trachea.

If there is too much flexion of the head toward the chest, you may not be able to directly visualize the glottis.*By snapping the laryngoscope blade into position on the handle, the light should turn on. Hold the laryngoscope in your left hand between your thumb and first 2 or 3 fingers, with the blade pointing away from you. One or 2 fingers should be left free to rest on the newborns face to provide stability.

The laryngoscope is designed to be held in the left hand by both right- and left-handed persons. If held in the right hand, the closed curved part of the blade will block the view of the glottis, making insertion of the endotracheal tube impossible.

Instructor Tip: Place the laryngoscope in the left hand of the operator, or lay it on the left side of the radiant warmer mattress.

*During an actual resuscitation, the process of intubation needs to be completed very quickly, within approximately 20 seconds. The newborn will not be ventilated during this process, so quick action is essential.

Stabilize the newborns head with your right hand. It may be helpful to have a second person hold the head in the desired sniffing position. Free-flow oxygen should be provided throughout the procedure.*Slide the laryngoscope blade over the right side of the tongue, pushing the tongue to the left side of the mouth and advancing the blade until the tip lies in the vallecula, just beyond the base of the tongue. You may need to use your right index finger to open the newborns mouth to make it easier to insert the laryngoscope.

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