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Airway management in the adult with direct airway trauma for emergency medicine and critical care

Airway management in patients who have sustained direct trauma to the airway is among the most challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway obstruction...

In some patients, a surgical airway may be the first and only choice for airway intervention. Severe injuries to the face, larynx, or supraglottic tissues may create an obstruction or an anatomic disruption that prevents the airway manager from gaining access to the glottis and performing tracheal intubation... Of note, there is no absolute contraindication to cricothyrotomy in a patient who is dying of respiratory…

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 Airway in Neck Trauma

Awake percutaneous cricothyroid puncture with insertion of an endotracheal tube – anatomy may be too abnormal - examine neck and attempt to palpate - apply anti-septic - infiltrate LA - make a punch stab through crico-thyroid membrane dilate with handle of scalpel - insert a size 6 or 7 cuffed ETT into trachea

Articles of Interest

Airway management in trauma

Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients.

First do no Harm: Rethinking Our Approach to Intubation in Trauma

With the majority of major trauma patients, intubation is not required immediately on patient arrival. There is some time to try to identify the presence of a physiologic threat and initiate resuscitation. Basic airway maneuvers as described above can be used to support the airway while this is done, and then a plan can be made for proceeding to intubation.

Management of the Trauma Patient’s Airway – Pearls and Pitfalls

Airway management is one of the most challenging and critical skills that the emergency medicine physician must master. This is particularly true in the setting of the trauma patient, where the ABCs of trauma evaluation begin with establishing the patency of the airway and ensuring adequate oxygenation and ventilation before moving through the remainder of the trauma algorithm.