Airway trauma is a critical and potentially life-threatening condition arising from blunt and penetrating injuries to the neck and the chest.1 Given the severity of these incidents, timely diagnosis and management become imperative for patient survival, as concomitant injuries and nonspecific symptoms may otherwise lead to fatal outcomes. The mortality of airway trauma victims is primarily attributed to hypoxia and airway mismanagement, factors known to contribute to up to 34% of prehospital deaths in these patients.2
Proper airway management is crucial when dealing with airway injuries. Prompt and efficient management not only ensures the patient’s immediate survival but also plays a pivotal role in minimizing the impact on respiratory function and overall quality of life. The main objective is to establish a secure and patent airway, enabling efficient ventilation and later surgical repair.
Upon the arrival of the adult trauma patient in the emergency department, there is a notable shift in the available choices for airway care. Within the emergency department, there is a diverse range of highly skilled individuals specialized in advanced airway management. Additionally, there is a wide range of available equipment, including various airway adjuncts.
This video delivers a thorough and detailed exposition of the equipment utilized in the airway management. Beginning with the basic preoxygenation equipment, simple high-flow nasal cannulas emerge as a primary tool, capable of delivering a continuous flow of oxygen reaching up to 70 L/min. This straightforward device is often the initial choice for oxygen supplementation. However, should this method prove insufficient, the tool in line is the non-rebreather mask equipped with a reservoir, ensuring the delivery of 100% oxygen. In cases where more robust intervention is warranted, the bag-valve-mask (BVM) steps into the spotlight. This device allows for continuous positive-pressure ventilation, ensuring a consistent flow of pure oxygen. However, difficulty with BVM ventilation should be anticipated in patients who have sustained severe maxillofacial injuries that disrupt bones and create instability or disfigurement in the middle or lower face.3
The subsequent section of the video showcases the practical demonstration of essential airway maintenance tools. Among these, the nasopharyngeal (NP) airway—a rubber tube inserted into the nostril—ensures unobstructed airflow. Absolute contraindications for placement of an NP airway include significant mid-face injuries with a suspicion for basilar skull fracture. Another option is an oropharyngeal (OP) airway. Both devices exist in a range of sizes suitable for all ages and can be used to maintain airway patency, particularly during BVM ventilation. The OP airway can induce gagging and vomiting in conscious patients, and therefore it should only be used for unresponsive patients. However, before initiating any of the airway maintenance strategies, it is essential to clear any blood clots, mucus, gastric contents, or tissue debris from the airways with the help of suctioning tools.
A demonstration featuring supraglottic airway devices follows. The latter open the upper airway invasively, allowing for unobstructed ventilation when the methods above prove unsuccessful. These may also be a suitable replacement for other airway management devices. According to recent insights, supraglottic airway device placement for rescue ventilation has more than 60% success rate in patients for whom tracheal intubation and mask ventilation are impossible.4 The King’s airway, a supraglottic airway device, provides an effective means of establishing and maintaining a patent airway. The laryngoscope is an essential instrument that aids in the visualization of the glottis during the process of intubation. Its evolution into the video laryngoscope, featuring a hypercurved blade, enhances the visualization of the airway, aiding in challenging intubation scenarios. The endotracheal tube, a conduit for securing the airway, is carefully guided through a laryngoscope, ensuring precise and controlled intubation in various clinical settings.
When traditional methods are ineffective, it becomes necessary to utilize rescue airway equipment. The bougie stands out as a unique tool, providing a tactile and precise method for navigating challenging airways. Additionally, the fiberoptic scope, with its advanced optics, assists in navigating airways with altered anatomy.
Lastly, a cricothyroidotomy kit is displayed. Cricothyroidotomy is a rare medical surgery where a tube is inserted via an incision in the cricothyroid membrane to create an airway for oxygenation and ventilation. In cases where non-surgical airway procedures have been unsuccessful or are not suitable, the use of this technique can be crucial for saving the patient's life. It is particularly useful in situations where the patient cannot be intubated or oxygenated, sometimes known as "can't intubate, can't oxygenate" (CICO) scenarios.
In summary, efficient airway management is paramount to addressing airway trauma, necessitating a comprehensive approach involving timely diagnosis, appropriate interventions, and the use of specialized equipment to ensure optimal patient outcomes.
- Bhojani RA, Rosenbaum DH, Dikmen E, et al. Contemporary assessment of laryngotracheal trauma. J Thorac Cardiovasc Surg. 2005;130(2). doi:10.1016/j.jtcvs.2004.12.020.
- Hussain LM, Redmond AD. Are pre-hospital deaths from accidental injury preventable? BMJ. 1994;308(6936). doi:10.1136/bmj.308.6936.1077.
- Krausz AA, El-Naaj IA, Barak M. Maxillofacial trauma patient: coping with the difficult airway. World J Emerg Surg. 2009;4(1). doi:10.1186/1749-7922-4-21.
- Thomsen JLD, Nørskov AK, Rosenstock CV. Supraglottic airway devices in difficult airway management: a retrospective cohort study of 658,104 general anaesthetics registered in the Danish Anaesthesia Database. Anaesthesia. 2019;74(2). doi:10.1111/anae.14443.