Page 41 - ATP-P 11th Ed

Respiration and Ventilation
Background
Respiration is the process of gas exchange at the cellular level. Oxygen is conducted into
the lung and taken up by the blood via hemoglobin to be transported throughout the body. SECTION 1
In the peripheral tissues, carbon dioxide is exchanged for oxygen, which is transported by
the blood to the lungs, where it is exhaled. This process is essential to cellular and organism
survival. Dysfunction of this process is a feature of multiple-injury patterns that can lead to
increased morbidity and mortality.
Table 4 PCC Role-based Guidelines for Respiration Management
PCC Role-based Guidelines for Respiration Management
T T T T *All Personnel - Complete Basic TCCC Management Plan for Respiration then:
C C C C • Identify Respiratory distress.
C C C C • Some Level 1 providers may be trained in Basic Life Support (BLS), and if so, may offer
C C C C the following interventions:
- - - - » Open the airway using Head Tilt or Jaw Thrust maneuver.
A C C C » Provide rescue breaths per BLS.
S L M P
M S C P
• Perform all recommended interventions from guidelines for above Tier level
• Additional interventions include:
» Use Bag Valve Mask with PEEP Valve.
» Use NPA.
• Ensure all interventions noted above are completed by TCCC ASM and CLS personnel.
• Conduct inventory of all resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
» Target ventilation to pulse oximetry level of 92%; use supplemental oxygen if available.
» Use end-tidal carbon dioxide monitor and maintain EtCO between 35–45mmHg.
2
» If definitive airway is required, consider cricothyrotomy tube as less sedation and pain
management is required to facilitate a patent and secure method for respirations.
• Ensure interventions noted above are completed by TCCC ASM, CLS, and CMC personnel.
• Conduct inventory of all resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
Mechanical Ventilation (For trained providers)
• Use of mechanical ventilators in the PCC environment requires experience and training,
best accomplished under board-certified medical personnel and sustained routinely.
• Ensure appropriate amount of induction, sedation, and pain management to sustain the
patient for up to 96 hours in a PCC environment.
Role 1a
• BVM, NPA, Pulse oximetry to maintain >92%.
• Intubate if no gag reflex and casualty is salvageable (TBI).
Role 1b
• Add EtCO monitoring, goal 35–45mmHg; initiate mechanical ventilation.
2
Role 1c
• Establish sedation, pain management maintenance plan for >96 hours; use non-invasive
ventilation as able.
• Monitor ABGs.
30 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 31