Oxygenation and Ventilation

Maintenance of tissue oxygen delivery requires, first and foremost, an assessment of the adequacy of oxygenation and ventilation. Items requiring immediate evaluation include airway patency, skin color, depth and rate of respiration, as well as the presence of any mechanical obstruction to ventilation including pneumothorax, hemothorax, or flail chest. Supplemental oxygen should be administered to all patients in shock and to most patients who are bleeding acutely. Many patients will require endotracheal intubation and ventilatory support. Respiratory arrest caused by fatigue of the intercostal muscles and diaphragm commonly precedes cardiac arrest as a terminal event in hemorrhagic shock; therefore it is essential that liberal guidelines for ventilatory support be used.

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