Stepwise airway management in the trauma patient

Abstract

The importance of establishing and maintaining a patent airway is a wellrecognized principle in the resuscitation of all trauma victims. Many currently available guidelines for airway management in trauma patients have been aimed largely at anaesthetists or those with anaesthetic training. Typically they concentrate on either those patients who require intubation, with techniques to use when this fails, or those in whom little intervention beyond facemask oxygen is required. In reality, clinicians with varying degrees of skill will be faced with managing the trauma patient's airway and many will not be able to safely attempt tracheal intubation. A pragmatic approach to airway assessment and management is presented that recognizes the variation in skills between clinicians. We also suggest that the role of supraglottic airway devices should now be recognized by all clinicians involved with airway management, particularly those not skilled in tracheal intubation and they should become an integral part of airway management.

Morpho-Volumetric Changes of the Pharyngeal Airway With Traumatic Maxillofacial Injuries: A Retrospective Radiographic Study

“…The consequences of MFTs vary and negatively affect the quality of life. Most cases require management under general anesthesia with oropharyngeal or nasopharyngeal intubation, which is a complicated issue in cases of severe MFTs [9,11,14,25]. In MFTs, the airway might get compromised or obstructed by means of foreign bodies, laryngeal injuries, hematoma formation, edema in fracture areas, and displacement of anatomic structures, such as the tongue in cases of bilateral parasymphyseal fractures [26].…”

“…Regarding the patient's airway, maxillofacial trauma (MFT) presents a complex issue [9,10]. Airway narrowing or obstruction could be due to the posteroinferior displacement of a fractured maxilla, bilateral fracture of the anterior mandible that may cause posterior displacement of the tongue, and soft tissue swelling and edema resulting from trauma to the head and neck [9,[11][12][13][14][15].…”

“…Intubation for the emergency management of severe MFT is usually difficult due to narrowing and changes in the morphology of the upper airway with limited mouth opening [9,11,16,17]. The upper airway is a complex structure that plays several vital roles in the human body, including respiration, food intake, and Computed tomography (CT) or cone-beam computed tomography (CBCT) can be used to assess airway volume and morphology.…”

Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department--a systematic review

“…Carley reviews airway assessment and scoring systems used to predict difficult intubation in more detail and with direct relevance to the trauma patient. 75 Oral endotracheal intubation is the technique of choice. Techniques such as BURP (Backwards, Upwards and Right Pressure) may supplement cricoid pressure if the vocal cords are not immediately visualised on laryngoscopy.…”

Risks in the Management of Polytrauma Patients: Clinical Insights

“…Airway assessment and management remain the priority in the ATLS algorithm during polytrauma resuscitation. 27 Any trauma victim is considered to have a difficult airway unless the mechanism of injury does not suggest cervical spine trauma. Careful consideration of cervical spine injury should dictate the airway interventions required which in most cases will require cervical spine stabilisation with cervical collar.…”