Airway trauma

 

Issues:

Airway

          Damaged?

          Obstructed?

          Full stomach?

Breathing

          IPPV possible?

          IPPV safe? (e.g. pneumothorax)

Circulation

          Is there shock?

          Is there bleeding?

Disability

          Co-operative?

 

Injury patterns:

Maxillofacial trauma

      Bleeding+++

      Rogered nasopharynx

      Associated with C-spine injury

Blunt neck trauma

      Laryngotracheal disruption common

      Many causes of obstruction (deformity, bleeding, swelling)

Penetrating neck trauma

      Associated with chest wall trauma (pneumo, haemothorax)

Airway burns

      If trapped in an enclosed space

      Risk of oedema -> obstruction

      Use nasendoscopy to predict need for intubation

      Avoid excess IV fluid

 

Airway planning:

Timing

     In extremis -> now

     Threatened -> after temporization

     Stable -> after proper assessment

Location

     Would theatre be safer?

     Is there time to transfer?

Equipment

     What is needed at hand?

     What is needed close by?

Personnel

     Need anaesthetic nurse?

     Need second anaesthetist?

     Need ENT surgeon?

 

 

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