Airway management in trauma.
Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.
Department of Anesthesiology and Resuscitation, Pitié-Salpétrière Hospital, Paris, France. olivier.langeron@psl.ap-hop-paris.fr
O
O
Langeron
A
A
Birenbaum
J
J
Amour
D000402:Airway Obstruction / Q000628:therapy*; D002574:Cervical Vertebrae / Q000293:injuries; D006259:Craniocerebral Trauma / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007103:Immobilization / Q000379:methods; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods; D019838:Neck Injuries / Q000628:therapy; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D010100:Oxygen / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D013390:Succinylcholine / Q000008:administration & dosage; D014172:Transillumination / Q000295:instrumentation; D014947:Wounds and Injuries / Q000628:therapy*
D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D010100:Oxygen