Primary survey x ray cervical spine4/22/2024 ![]() ![]() Ketamine is the most appropriate anaesthetic agent in the context of trauma to maintain BP and cerebral perfusion pressure (CPP) during induction. Prior to attempting intubation, always have a plan for managing a difficult airway or failed intubation. Verbalise this plan to the trauma team. Only an experienced clinician should attempt intubation in a young child, unless the procedure is required to save life. a requirement for definitive airway protectionĬonsider use of LMA or 2-person bag/mask ventilation if ventilation is difficult.neurologically flaccid, decerebrate/decorticate posturing.adequate ventilation using a bag valve mask is not possible.ongoing airway obstruction is present despite OPA.Listen for any upper-airway noises such as stridor.Ĭonsider intubation early if any of the following apply: If the child is unstable, examine for signs of possible airway obstruction (use of accessory muscles, cyanosis, visible swelling of the tongue/pharynx or neck, facial trauma, any obvious foreign bodies in the oral cavity). (see section on cervical spine management or Royal Children’s Hospital Cervical Spine Clinical Practice Guideline)Īssess for airway stabilityIf the child is stable and the airway is patent, continue to provide oxygen via a non-rebreather mask at 10 L/min. This should be on the hospital bed prior to moving from the ambulance trolley. A towel or thoracic elevation device should be placed under the shoulders to raise them 2-4cm and rest the head in a neutral position. When placed flat on a firm surface the size of the head tends to force the neck into flexion losing the desired neutral spine position and potentially obstructing the airway. Children have a head which is disproportionately larger than their neck and bodies. Deterioration can be sudden: it is essential to have emergency airway equipment always available.Īssess the airway while protecting the cervical spine. Top of page Airway with cervical spine protectionContinuous monitoring of airway patency is essential throughout management. A cuff that is too narrow will overestimate, and a cuff that is too wide will underestimate the blood pressure.Īll monitoring should be maintained until the retrieval team arrives. To measure blood pressure correctly, the cuff should be two-thirds of the length of the medial aspect of the upper arm. Monitoring of peripheral perfusion and temperature should also be undertaken. The heart rate, respiration rate, blood pressure and oxygen saturation should be recorded at 15 minute intervals or more frequently if indicated. The following vital signs should be utilised to identify a need for escalation in patient management and further consultation regarding management. The goal is to identify and manage any immediate threat to life and to identify any potential threats. Primary Survey and Early Management Use a systematic approach based on the ABCDE survey to assess and treat the acutely injured child. ![]()
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