54: Trauma

CHAPTER 54 Trauma

7 How does an uncleared cervical spine modify the approach to the airway?

Patients requiring emergent surgical procedures do not have time to have their cervical spines evaluated fully. There is no airway management technique that results in no cervical motion. However, there is no documentation of iatrogenic neurologic injury in patients with cervical fractures when cervical spine precautions are used. These precautions include an appropriately sized Philadelphia collar, sand bags placed on each side of the head and neck, and the patient resting on a hard board with the forehead taped and secured to it.

Alternative airway management techniques in the traumatized patient include rapid-sequence induction with in-line stabilization, use of the Bullard laryngoscope, blind nasal intubation, and fiber-optic bronchoscopic-assisted ventilation. A Glidescope is a laryngscope with a camera lens on its tip and is very useful when a patient’s neck must be maintained in a neutral position. An unstable or uncooperative patient likely would receive a rapid-sequence induction.

When a cervical fracture or cervical spinal cord injury (SCI) is documented, most anesthesiologists choose fiber-optic intubation facilitated by some form of topical anesthesia to the airway and sedation, titrated to effect, keeping in mind the patient’s other injuries and hemodynamic status. This allows postintubation assessment of neurologic status before induction of unconsciousness. It would not be advisable to ablate all protective airway reflexes in a patient with a full stomach.

May 31, 2016 | Posted by in ANESTHESIA | Comments Off on 54: Trauma
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