Trauma and airway

Q: Which of the following is the direct sign of airway compromise during trauma?

A) Stridor

B) Drooling

C) Trismus

D) Odynophagia

E) Tracheal deviation

Answer: A

Securing the airway is the foremost priority in trauma as there may not be any luxury of time. A clinician needs to be very prudent in securing airway. Airway comprises during trauma can be divided into three time-sensitive classes.

• Direct signs of airway compromise
• Indirect signs of airway compromise
• Signs of developing airway compromise

Dyspnea and stridor (choice A) are the most worrisome direct signs of airway compromise. All other choices given in the above question i.e., B, C, D & E are the indirect signs of airway compromise. Signs of developing airway compromise should be watched carefully and should be under constant consideration for early securement of the airway. Those are non-superficial burns of the face or neck, bleeding noted in the oropharynx or nasopharynx, crepitus or hematoma over the neck, face or chest, change of voice and subjective sense of shortness of breath despite normal oxygen saturation.

#trauma

References:

1.  Ollerton JE. NSW Institute of trauma and injury management. North Ryde: NSW; 2007. Adult trauma clinical practice guidelines: Emergency airway management in the trauma patients

2. Talucci R, Shaikh K, Schwab C. Rapid sequence induction with oral endotracheal intubation in the multiple injured patient. AmSurg. 1988;54:185–7

3. McGill J. Airway management in trauma: An update. Emerg Med Clin N Am. 2007;25:603–22.

4. Hagberg CA. The traumatized airway: Principles of airway management in the trauma patient. In: Hagberg CA, editor. Benumof's Airway Management. 2nd ed. New York: Mosby Elsevier Inc; 2008