In-hospital management of the airway in trauma

Question 1

Factors that cause difficult airways in trauma

Answer 1

• Unknown fasting status
• Cervical spine instability and MILS
• Airway swelling
• Distorted anatomy
• Foreign material in the airway - blood, sputum, aspiration, teeth
• Agitation

Question 2

Methods to assess the airway in trauma

Answer 2

• modified LEMON
• FNE
• USS neck for FONA

Question 3

Goals of airway management in trauma

Answer 3

Primary
- Intubate successfully in the shortest possible time
- Maintain oxygenation and ventilation
- Protect the lungs from aspiration

Secondary
- Facilitate hospital transfer
- Facilitate urgent surgery
- Controlled ventilation in suspected brain injury

Question 4

Facial Fractures and Airway Management

Answer 4

• Active bleeding in the airway
• Teeth and bone fragments in the airway
• Trismus causing reduced mouth opening
• If mid or lower-face fracture posterior displacement of the fracture can obstruct the airway and injure the oesophagus leading to pneumomediastinum and s/c emphysema
• Haematoma formation can cause laryngotracheal compression
• Often associated with skull base fractures
• Routine airway manoeuvres and adjunct placement may not be possible

Question 5

Burns and Airway Management

Answer 5

• Stridor, hoarse voice, blackened secretions, oropharyngeal swelling = inhalational burns
• Upper airway FNE is generally well tolerated and predicts need for intubation
• Early tracheal intubation is indicated
• As big a tube as possible, left uncut