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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