Airway management: the difficult airway

Abstract

Maintenance of a patent airway to allow ventilation with high concentration oxygen is an essential procedure during the resuscitation of all trauma patients. A range of equipment is available to help achieve and maintain a clear airway, with endotracheal intubation remaining the gold standard. However, in trauma patients attempts at intubation are often impeded by the presence of associated injuries and the application of devices to immobilize the cervical spine. In the situation of ‘can’t ventilate, can’t intubate’ a surgical airway can be life-saving while expert help is sought. Recently, new devices, in particular the laryngeal mask airway and Combitube®, have gained recognition as having a role in difficult airway management when other methods have failed, thereby reducing the need for surgical intervention. This paper presents an overview of the currently accepted methodology of managing the difficult airway in the trauma patient.

Stepwise airway management in the trauma patient

“…Fortunately, the incidence of 'can't intubate, can't ventilate' is much lower (0.01-0.03% cases) (Cheney, 1994). However, overall, in patients in the emergency department the incidence of both is significantly higher (Walls et al, 1997;Tayal et al, 1999;Calderon et al, 1995), with trauma patients having their own recognized causes of difficulty with tracheal intubation (Bryden and Gwinnutt, 2000) ( Table 2).…”

Anaesthesia in trauma

“…In some trauma patients, dif®culties will be encountered with tracheal intubation. A variety of techniques have been described previously (Bryden and Gwinnutt, 2000).…”