Airway management after major trauma

Abstract

The primary goal in the early management of the severely-injured patient is the provision of sufficient oxygen to the tissues to avoid organ failure and secondary central nervous system damage. The first priority is to establish and maintain a patent airway. With the addition of high-concentration oxygen and the presence of adequate tissue perfusion, this will enable sufficient spontaneous breathing or assisted ventilation to oxygenate the patient. The possibility of an unstable cervical injury exists in patients exposed to significant blunt trauma; during airway interventions, neck movement must be minimized to avoid secondary harm to the spinal cord. Depending on the series, 2–12% of major trauma victims have a cervical spine injury and 7–14% of these are unstable. Approximately 10% of comatose trauma patients have a cervical spine injury. Head injury with impaired consciousness and reduced pharyngeal tone is the commonest trauma-related cause of airway obstruction. The airway may also be soiled with blood or regurgitated matter. Blunt or penetrating injuries that obstruct the airway include maxillary, mandibular and laryngotracheal fractures, and large anterior neck haematomas. Significant partial and incipient airway obstruction are also potential causes of early death. Vigilant reassessment with immediate restoration and protection of airway patency is essential.