Читать книгу Emergency Medical Services - Группа авторов - Страница 58

A 34‐year‐old, 6‐ft, 100‐kg, unhelmeted male operator of an ATV is thrown from the vehicle. An air medical crew arrives, completes their survey, places the patient on a cardiac monitor, establishes a 20G peripheral IV, and starts a normal saline infusion. The patient’s Glasgow Coma Scale score is 7, systolic blood pressure 104/50 mmHg, pulse 128/min, respiratory rate 24/min, and oxygen saturation 94% on 15 liters per minute via non‐rebreather mask.

The crew assesses the patient’s airway using the LEMON method. They Look externally, noting a possible fractured jaw, and then Evaluate using the 3‐3‐2 rule, noting that they can place three fingers in the mouth, three fingers from the angle of the jaw to the mentum, and two fingers from the thyroid cartilage to the bottom of the jaw. The mandible is not receding. They assess Obstruction using a modified Mallampati, which provides a clear view of the posterior oropharynx and uvula when they suction blood from the mouth. Lastly, rather than assess neck Mobility, they remove the patient’s cervical collar and hold inline stabilization from below.

They use an airway checklist to prepare for intubation. They check their bag‐valve‐mask, oxygen, and suction device. The IV is patent. The patient’s pulse oximetry, pulse rate, and blood pressure are normal. They deliver oxygen via nasal cannula at 15 liters per minute to provide apneic oxygenation. They prepare 8.0‐mm and 7.5‐mm endotracheal tubes. They inspect the 8.0‐mm balloon and lubricate and insert a stylet. They turn on the video laryngoscope and begin recording. The crew connects a waveform capnograph and prepares a tube holder. They identify an appropriately sized supraglottic airway and place it adjacent to the patient’s chest as a contingency. They administer rocuronium and ketamine and the patient is oxygenated with a BVM. Once the patient is no longer breathing, they place the video scope while suctioning, and pass the tube through the cords under visualization. They inflate the balloon and confirm placement by EtCO2 and five‐point auscultation. They secure the tube with a tube holder, and reassess the patient to ensure stable vitals. The crew sedates the patient and places restraints to preclude self‐extubation.