Airway Management in Trauma
Apr 18, 2025
Airway management in trauma
Assessing the airway of a trauma patient is rife with challenges and roadblocks, in what is a dynamic and time critical situation. Assessment needs to occur rapidly in order to ensure adequate oxygenation and ventilation to the patient, protect the airway from potential aspiration, and facilitate emergency surgery.
Some of these roadblocks include:
π Limited time for assessment
π₯ Unknown fasting status
𦴠Uncertainty regarding the C-spine, precluding airway manoeuvres
π· Potential airway swelling or distorted anatomy
π§Ό Soiling of the airway
π€ Uncooperative patient due to hypoxia, head injury, intoxication and so on
When assessing and managing the trauma airway, these 5 steps can help to provide structure and guidance and ensure that critical information/steps are not overlooked.
Airway assessment:
π Is the patient obtunded or cyanosed?
π¨ Accessory muscle use?
𦴠neck trauma or tracheal deviation?
π airway noise?
π Look for signs of difficult airway such as small chin, facial hair etc
Airway management:
β chin lift or jaw thrust manoeuvre (while maintaining neural spine)
π§Ή suction the airway
ππ if remains obstructed, consider naso/oropharyngeal airway
π progress to definitive airway if: apnoeic, unable to maintain airway patency, risk of aspiration, GCS < 8
Ventilation assessment:
ποΈπ¨οΈ Assess chest rise and fall for symmetry
π§ Auscultate the chest
π€²π§ Palpate and auscultate the chest for signs of injury such as surgical emphysema and pneumothorax
π Utilise pulse oximetry and blood gas analysis
Ventilation management:
π¨ All trauma patients should receive supplemental oxygen whether they are intubated or not
π If tension pneumothorax is suspected, needle decompression should be performed as soon as possible
Reassessment:
π Steps 1 - 4 should be re-assessed on a regular basis to ensure ongoing airway patency and adequate ventilation is occurring
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References:
Athanassoglou, V., Rogers, A., Hofmeyr, R. (2024). In-hospital management of the airway in trauma. BJA education. DOI: 10.1016/j.bjae.2024.03.004
Institute of trauma and injury management (2007). Emergency airway management in the trauma patient. NSW health. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0011/195167/NSW-Health-ITIM-Emergency-airway-management-trauma-patient-summary.pdf
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