Airway managment in Trauma

Last Updated on by FRCEM Intermediate

What are the indications for the intubation in Major trauma?

  • Facilitate oxygenation and ventilation
  • airway protection
  • prevent impending, or overcome airway obstruction
  • humanitarian reasons (e.g. provide analgesia and anesthesia for procedures)
  • neuroprotection (e.g. targeted PCO2 management)
  • allow safe transfer

Issues in managing airway in trauma patients 

  • Full stomach and aspiration risk
  • cricoid pressure is controversial – it is contra-indicated in laryngeal trauma and may worsen laryngeal visualization or cause airway obstruction
  • Manual in-line stabilization (MILS) of the cervical spine should be maintained in unconscious patients
  • Jaw thrust is the preferred airway opening maneuver
  • head-tilt chin lift is not performed due to the risk of cervical spine instability
  • a suspected base of skull fracture is a relative contra-indication to nasopharyngeal airway insertion
  • difficult ventilation e.g. poorly fitting mask in facial trauma, traumatic airway leak, poor compliance in chest trauma (List Some Reasons for Difficult ventilations)
  • endotracheal intubation via the oral route may be impossible due to mechanical trismus or airway trauma. many trauma airway experts advise the use of a bougie or stylet as direct laryngoscopy and intubation is more difficult, due to: (List Some Reasons for Difficult intubation)
    • local swelling and deformity
    • impaired visualization due to deformity and debris (hemorrhage may obscure video laryngoscopy)
    • restricted movement of the neck during MILS
  • emergency surgical airways are more difficult, due to: (List Some Reasons for Difficult surgical airway)
    • local swelling and deformity
    • an inability to extend the neck during MILS
  • hemodynamic instability may occur post-intubation (why hemodynamic instability may occur post-intubation? )
    • a vagal response in neurogenic shock may result in severe bradycardia or asystole (treat with atropine)
    • hypotension may result from induction agents, hemorrhagic shock or neurogenic shock

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