2 - Trauma Airway Management

Summary

Objectives

1. Review the major considerations and tools needed for trauma airway management.

2. Characterize the difficult airway in trauma.

3. Evaluate the American Society of Anesthesiologists' difficult airway algorithm with regard to trauma.

4. Provide a plan for managing common trauma difficult airway scenarios.

INTRODUCTION

Airway management disasters account for a large proportion of malpractice lawsuits in the American Society of Anesthesiologists' (ASA) Closed Claims database [1]. Airway loss is a major cause of preventable prehospital death in trauma patients [2]. Trauma airway management is complicated because of associated pathology and suboptimal intubating conditions, and also because complete preintubation evaluation and planning is rarely possible. Furthermore, trauma patients are at increased risk for hypoxia, airway obstruction, hypoventilation, hypotension, and aspiration.

A significant reduction in airway management claims has occurred over the past decade due to the introduction of the ASA difficult airway algorithm, which institutionalized the need for airway evaluation, awake intubation techniques, and the use of back-up rescue modalities such as laryngeal mask airway (LMA), esophageal-tracheal-combitube (Combitube), and transtracheal jet ventilation (TTJV) [1]. It is therefore logical that incorporation of the ASA difficult airway algorithm, with certain minor modifications, can likewise improve safety during trauma airway management.

This review of airway management for trauma begins with a survey of the equipment and drugs that should be prepared ahead of time, defines and characterizes the “difficult airway,” and describes the principles of airway evaluation and management for the trauma patient under both elective and emergency conditions.