Airway Trauma

 

(I have made some modifications to this one)

 

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 mindsets:

1.In extremis

“Crack on”

Definitive airway management right here, right now

·      No time for assessment and optimisation

2.Threatened

“Stay and play”

Definitive airway management after temporization

·      Brief assessment and optimization

·      Nasendoscopy

3.Stable

“Head for home”

Definitive airway management at leisure

·      Thorough assessment and optimisation

·      Nasendoscopy

·      CT neck

 

Airway planning:

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?

 

Airway options:

Awake intubation

·      Minimises risk of failure and aspiration

·      Requires co-operation

·      Remifentanil helpful

·      Can do ETT or FONA

Spont vent

·      TIVA likely safer than volatile (NAP4)

·      Can do ETT or FONA

RSI

·      ETT via video laryngoscope +/- fibreoptic bronchoscope

·      Need two anaesthetists

 

Factors affecting triage decision:

Airway

·      Nature of injury

·      Complexity

·      Stability

Patient

·      Aspiration risk

·      Compliance

Team

·      Numbers

·      Skills

Location

·      Space

·      Equipment

·      Monitoring

Circumstances

·      Distance to theatre

·      Availability of theatre

·      Time of day

 

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