ATLS Airway and Ventilation

Securing a compromised airway, delivering oxygen, and supporting ventilation take priority over management of all other conditions. Supplemental oxygen must be administered to all severely injured trauma patients.

Airway

Airway compromise can be dynamic, late presenting, and insidious. Frequently reassess by talking to the patient. Is their verbal response adequate and clear?

• Consider early intubation for decreased neurologic status, airway burns.
• Midfacial trauma can lead to fractures and dislocations that compromise the nasopharynx and oropharynx, leading to loss of airway structural support.
  • increased risk with providing anesthesia and sedation due to loss of muscle tone
  • consider early intubation
• Neck trauma (blunt, penetrating) can lead to massive neck hematomas with respiratory compromise. May need a surgical airway.
• Tracheal or laryngeal injury can cause sudden complete occlusion. Consider surgical airway support.

Ventilation

A definitive airway requires a tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to some form of oxygen-enriched assisted ventilation, and the airway secured in place with an appropriate stabilization method.

Consider having RSI medications and airway cart ready to go prior to the patient arriving.