Traumatized Airway
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Airway management is of paramount importance in caring for the trauma patient. The primary goals of airway intervention are to relieve or prevent airway obstruction, to secure the unprotected airway from aspiration, to provide adequate gas exchange, and to maintain cervical spine stabilization. Acute airway trauma is a rare yet potentially lethal injury that is often difficult to diagnose. Recent literature estimates the incidence of airway trauma is less than 0.1% of all trauma patients; however, the mortality of these injuries is high—up to 20% for blunt trauma and up to 40% for penetrating trauma [1,2]. Long-term outcomes are usually favorable if the patient is treated within 24 hours of presentation, but more than 60% of patients have other associated injuries, making diagnosis and management problematic [1,3,4].
Analgesia, sedation and emergency anaesthesia
Ian Greaves, Keith Porter, Chris Wright in Trauma Care Pre-Hospital Manual, 2018
Advanced airway equipment, suction and emergency drugs are essential in order to allow reversal of the sedation or conversion to general anaesthesia in the event of problems arising. Airway management techniques are discussed in Chapter 8. Pre-hospital sedation must not be undertaken by those who do not have the necessary skills to proceed to the induction of anaesthesia, including a full range of airway techniques up to and including surgical airway. Two practitioners must be present during induction and maintenance of sedation. Ideally the patient should have fasted for at least 4 hours (24,25), although this is unlikely to be the case in pre-hospital care. Just as in hospital practice, consent should be sought for the sedation as well as the procedure: in pre-hospital care, this is likely to be witnessed verbal consent (26).
Recognition and Management of the Difficult Airway
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Immediate morbidity or mortality from difficult airway management arise from the effects of severe hypoxia, hypercarbia or cardiovascular responses, from failure to adequately protect the airway leading to aspiration and from physical trauma to the airway during attempts at intubation or resuscitation. Airway damage may occur even when airway management has not been notably difficult. Valuable information can be obtained from detailed analysis of the medical information contained in insurance reports, once claims for negligence have been settled or closed. In an analysis of such closed claims in North America,73 6% of 4460 claims were for airway injury. The most frequent sites of injury were the larynx (33%), pharynx (19%) and oesophagus (18%). Approximately 20% of laryngeal injuries were associated with difficult intubation and included granuloma formation, arytenoid dislocation and hoarseness. Injuries to the pharynx and oesophagus had a much stronger association with difficult airway management. Half of all pharyngeal injuries and 68% of pharyngeal perforations were associated with difficult intubation.
Intubation Success in Critical Care Transport: A Multicenter Study
Published in Prehospital Emergency Care, 2018
Ryan J. Reichert, Megan Gothard, M. David Gothard, Hamilton P. Schwartz, Michael T. Bigham
Airway management is essential to the provision of comprehensive and essential medical care to transported patients. This report aims to describe the state of TI success in the specialized medical setting of CCT and is the largest of its kind, evaluating more than 85,000 CCT patient contacts. We report that 4.7% of patient contacts were intubated by CCT teams. The overall TI success rate of 82% falls below the adult CCT TI success rate but within the range of previous studies looking at pediatric CCT TI (18–20). The rate is also shown to be better than reported prehospital rates but worse than in-hospital rates (10, 11, 14, 6, 17). We believe that the particularities of the transport setting and its environment and lack of controlled nature compared to the in-hospital setting may play a role in this worse performance. In addition, CCT teams are frequently faced with patients with difficult airways in an acute phase of care, perhaps also accounting for the worse TI success rates. Of importance, we demonstrate with this study the largest data set to date on the overall rate of intubation success in the CCT setting. We believe that the inclusion of program type, patient age, and intubation complications (i.e., DASH-1A) is vital to providing a clearer picture of the factors contributing to intubation success in this setting.
A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success
Published in Prehospital Emergency Care, 2018
David J. Olvera, David F. E. Stuhlmiller, Allen Wolfe, Charles F. Swearingen, Troy Pennington, Daniel P. Davis
Airway management is an essential skill in the stabilization and management of critically ill or injured patients. The rate of complications during attempted endotracheal intubation (ETI) has been reported as high as 48% in the prehospital setting (1–3). These complications, which include intubation failure, desaturations, and post-intubation hyperventilation, appear to be responsible for our inability to demonstrate improved outcomes with prehospital ETI. This is critically important with use of paralytic medications as part of a rapid sequence intubation (RSI) procedure, as the resultant apnea places maintenance of oxygenation and ventilation completely in the hands of health care providers. Thus, identifying strategies to optimize RSI performance, maximize ETI success, and avoid error is critically important to reducing morbidity and mortality.
Skin problems related to personal protective equipment among healthcare workers during the COVID-19 pandemic (online research)
Published in Cutaneous and Ocular Toxicology, 2021
Airway management should be safe for medical staff and patients, accurate, and fast. Tracheal intubation should be the first choice. Airway management should preferably be performed by an experienced physician. It is recommended to lessen the number of team members in the room. High-flow oxygen should be avoided. It is advised to choose surgical cricothyroidotomy instead of needle cricothyroidotomy. Team members should use N95/FFP3 masks and eye and face protection, and disposable gowns and gloves31. Ophthalmologists are at risk of viral spread because ophthalmic equipment can be contaminated by respiratory droplets, tears, and conjunctival secretions. Appropriate cleaning agents must be used to reduce contamination. During surgery, appropriate PPE such as N95 masks and goggles should be worn by all staff in the operating room32.
Related Knowledge Centers
- Abdominal Thrusts
- Advanced Airway Management
- Airway Obstruction
- Nasopharyngeal Airway
- Obtundation
- Pulmonary Aspiration
- Tracheal Intubation
- Anaphylaxis
- Oropharyngeal Airway
- Basic Airway Management