tintinallisemergencymedicinesection3resuscitative.docVIP

Tintinallis Emergency Medicine Section 3: Resuscitative Problems and Techniques Chapter 19. Tracheal Intubation and Mechanical Ventilation Tracheal Intubation and Mechanical Ventilation: Introduction Airway integrity, assurance of oxygenation, ventilation, and prevention of aspiration are the mainstays of emergency airway management. The indications for tracheal intubation in the emergency setting most commonly include correction of hypoxia or hypercarbia, prevention of impending hypoventilation, and ensuring maintenance of a patent airway. Secondary indications include provision of a route for resuscitative medication administration and to permit temporizing paralysis during diagnostic testing. Orotracheal Intubation The most reliable way to ensure a patent airway, provide oxygenation and ventilation, and prevent aspiration is endotracheal intubation. Many unconscious and even conscious patients may be unable to spontaneously clear the airway of secretions, may require mechanical ventilation, may have aspirated, or lack protective airway reflexes.1 Preparation The clinical assessment of oxygenation and ventilation may be unreliable in a chaotic emergency department (ED). Continuous, noninvasive bedside monitoring of arterial oxygen saturation is helpful. Isolated oximetry does not assess the status of alveolar ventilation, whereas capnography does allow estimation of the partial pressure of carbon dioxide (PaCO2) based on the waveform display of the end-tidal partial pressure of carbon dioxide. Capnometry refers to the numerical display. In combination, these noninvasive modalities affect decisions regarding tracheal intubation. Checking the necessary equipment should be standard procedure for ED clinicians at the beginning of their clinical duties. The following items should be available: oral and nasal airways, different-size orotracheal tubes, an O2 setup that is appropriately connected, a self-inflating ventilation bag, different-size masks