Airway Obstruction in Trauma
1. Rapid Clinical Assessment
- ABCDEApproach
- Monitoring and Oxygenation:
- Provide high flow oxygen
- Maintain SpO₂ > 95%.
- Place the patient on a cardiac monitor.
- Establish intravenous (IV) access.
2. Identification of Airway Obstruction
Signs and Symptoms
- Unable to speak
- Stridor or wheezing sounds.
- Gurgling or snoring noises.
- Visible foreign bodies or facial deformities.
- Cyanosis.
- Use of accessory muscles for breathing.
- Decreased or absent breath sounds on one side.
Common Causes in Trauma
i. Facial Fractures:
- Le Fort fractures, mandibular fractures can displace facial structures.
ii. Swelling or Edema:
- Inhalation injuries, allergic reactions, angioedema.
iii. Hematoma:
- Blood accumulation in the airway from facial or neck injuries.
iv. Foreign Bodies:
- Objects inhaled or inserted into the airway.
v. Tracheal or Laryngeal Injuries:
- Resulting from blunt or penetrating trauma.
vi. Tongue Displacement:
- In unconscious patients, especially in supine position.
vii. Vomitus Aspiration:
- Risk in patients with altered mental status.
3. Immediate Management
A. Basic Airway Maneuvers
i. Head Tilt-Chin Lift
If not suspected cervical spine injury.
Technique:
- Tilt the head back and lift the chin upward to open the airway.
ii. Jaw Thrust Maneuver
Use in suspected cervical spine injury.
Technique:
- With hands on the patient's lower jaw, push the jaw forward without moving the neck.
B. Airway Adjuncts
i. Oropharyngeal Airway (OPA)
- Use only in unconscious patients without a gag reflex.
- Contraindications: Patients with a strong gag reflex or risk of vomiting.
ii. Nasopharyngeal Airway (NPA)
- Indications: Semi-conscious patients, those with intact gag reflex.
- Contraindications: Suspected basal skull fracture.
C. Supraglottic Airway Devices
Indications: When bag-valve-mask ventilation is inadequate, or in cases of difficult intubation.
Advantages: Easier and quicker to place than endotracheal tubes, less invasive.
D. Advanced Airway Management
i. Endotracheal Intubation
Indications: GCS ≤ 8, inability to protect airway, respiratory failure despite supplemental oxygen.
ii. Fiberoptic Intubation
Indications: Anatomical variations, severe facial trauma, or anticipated difficult airway.
Advantages: Enhanced visualization, minimal movement of cervical spine.
iii. Surgical Airway (Cricothyroidotomy or Tracheostomy)
Indications: Failed intubation attempts, airway obstruction that cannot be relieved by other means.