ANAESTHETICS AND AIRWAY
AIRWAY TRAUMA
PromptBLUNT
ResponseEg: Cricket ball vs neck
PromptDescribe your Immediate management of blunt airway trauma
ResponseStabilise neck with gentle immobilisation
Neb adrenaline 5 mg
IV dex 8 mg
Glycopyrolate 200 mics IV to minimise secretions
Apply oxygen
Call for assistance (Anasthetics, Retrieval, ENT)
Let patient assume position of comfort
Neb adrenaline 5 mg
IV dex 8 mg
Glycopyrolate 200 mics IV to minimise secretions
Apply oxygen
Call for assistance (Anasthetics, Retrieval, ENT)
Let patient assume position of comfort
PromptEquipment required for management of blunt neck trauma airway
ResponseVideolaryngoscope + direct backup + multiple blades
Bougie
LMA
Surgical airway kit - Scalpal, bougie, 6.0cuffed ETT, Artery forceps
Fibreoptic scope and anasthestist
Bougie
LMA
Surgical airway kit - Scalpal, bougie, 6.0cuffed ETT, Artery forceps
Fibreoptic scope and anasthestist
PromptPros/Cons of different methods of securing airway in blunt airway trauma
ResponseAkwake fibre optic in theatre with ENT backup
Pro: no need to RSI, less risk of CICO scenario. Can back off if poor view
Cons: needs anasthetics with special skills, delay may result in deterioration
RSI with surgical airway as backup
Pros: familiar and rapid
Cons: May fail, worsen situation as now paralysed/sedated
Surgical airway as primary
Pros: Overcomes supraglottic obstruction, can pass cuffed tube, definitive
Cons: Invasive, airway may be distorted in trauma, unfamiliar, failure
Pro: no need to RSI, less risk of CICO scenario. Can back off if poor view
Cons: needs anasthetics with special skills, delay may result in deterioration
RSI with surgical airway as backup
Pros: familiar and rapid
Cons: May fail, worsen situation as now paralysed/sedated
Surgical airway as primary
Pros: Overcomes supraglottic obstruction, can pass cuffed tube, definitive
Cons: Invasive, airway may be distorted in trauma, unfamiliar, failure
PromptDescribe awake fibreoptic technique in blunt airway trauma
ResponseSit up, explain, consent
Senior anaesthetist as proceduralist, RSI + Surgical airway as backup
Local anaesthetic spray - Cophenylcaine 6 sprays or 2% lignocaine nebulised (even low dose ketamine 20 mg)
Preload ETT on scope, View cords through scope, Pass through cords
Sedate
This was the “preferred technique” in blunt airway trauma
Senior anaesthetist as proceduralist, RSI + Surgical airway as backup
Local anaesthetic spray - Cophenylcaine 6 sprays or 2% lignocaine nebulised (even low dose ketamine 20 mg)
Preload ETT on scope, View cords through scope, Pass through cords
Sedate
This was the “preferred technique” in blunt airway trauma
PromptDescribe how you would approach an RSI in blunt airway trauma
ResponseSmaller ETT
Front of neck access - marked, prepped, team briefed, kit open
Use of awake fibreoptic instead
Sedation and laryngeal local anaesthesia (avoid paralysis)
No cricoid pressure or ELM
Gentle bougie technique - avold false airway tract with fractured larynx
Front of neck access - marked, prepped, team briefed, kit open
Use of awake fibreoptic instead
Sedation and laryngeal local anaesthesia (avoid paralysis)
No cricoid pressure or ELM
Gentle bougie technique - avold false airway tract with fractured larynx