Airway Management In Trauma

SUMMARY OF CHANGES

  1. The Airway Management of Traumatic Injuries CPG and the Airway Management in Prolonged Field Care Clinical Practice Guidelines (CPGs) were combined into a joint CPG to reduce redundancy. The new consolidated CPG is Airway Management in Trauma.
  2. Significant changes were made to the Purpose/Background and main body sections.
  3. The CPG was reorganized utilizing the SOAP ME (Suction, Oxygen, Airway, Pharmacy, Monitors/Machine, ETCO2 and other Equipment) acronym. SOAP ME is a reasonable approach to “cleaning up” airway management for patients with traumatic injuries.  It follows a more logical flow for the deployed provider.  The sequence is better aligned with the steps necessary to manage trauma airways in austere environments.
  4. Subsequent CPG sections were reordered, heavily edited, and updated.
  5. The discussion of resuscitation before intubation and the use of advanced airway adjuncts like supraglottic airways and video laryngoscopy were added.

PURPOSE

The intent of this Clinical Practice Guideline (CPG) is to provide evidence and experience-based solutions to those who manage airways in an austere environment. An emphasis is placed on utilizing the tools and adjuncts most often available in a resource-constrained environment. The JTS Mechanical Ventilation Basics CPG will address the specifics of mechanical ventilation. This CPG also introduces an acronym to assist providers and their teams in airway management for trauma and non-trauma patients in the operational environment.

BACKGROUND

Airway compromise is the second leading cause of potentially survivable death on the battlefield after hemorrhage.1 Complete airway occlusion can cause death from suffocation within minutes. Austere environments present significant challenges with airway management. Considerations include variable provider experience, limitations of available equipment and finite supplies such as supplemental oxygen, medications for induction and paralysis, as well as post-intubation management. Another current reality is limited exposure and sustainment training, especially for advanced airway techniques. Airway management algorithms may change based on caregiver skillset, indications and resources. An important principle of airway management is that definitive airways (e.g., endotracheal tube and cricothyroidotomy) should only be placed if indicated. Every attempt should be made to manage patients with airway adjuncts first. Remember, if an injured or critically ill patient is managing their airway on their own or with other adjuncts, placing a definitive airway is not a priority and other treatments should  be performed first. If a definitive airway is not indicated, giving induction and paralytic medications can make a bad problem much worse , especially in hemodynamically unstable patients. If a patient does require a definitive airway and is in hemorrhagic shock, ensure adequate volume resuscitation prior to induction/intubation in order to prevent cardiovascular collapse. The ability to rapidly and consistently manage an airway when indicated and prioritize other resuscitative needs may contribute to improved outcomes.2,3