Difficult Airway Management in Trauma: A Review of Current Guidelines - Trauma EXTRA Supplement (Trauma CME)

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Delivery Method:	Online
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Publication Date: August 2024 (Volume 27, Supplement 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 08/15/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

The American Society of Anesthesiologists and the United Kingdom's Difficult Airway Society have generated and revised guidelines over the past 30 years based on analyses of the causes of airway catastrophes. Guideline components include airway management algorithms, equipment standardization, and routine training. Algorithms utilize intubation, supraglottic airway insertion, fiberoptic intubation, awake intubation, and front of neck surgical access. This review summarizes difficult airway management guidelines and discusses their application to trauma patients, including patients with physiologically difficult airways and patients with maxillofacial and laryngotracheal trauma.

Case Presentations

A 24-year-old man arrives by private vehicle with a dish-face deformity (in which the face appears flattened or concave) as a result of an injury sustained while skiing...

• On examination, his face is free floating. He has bilateral periorbital hematomas and trismus.
• His Glascow Coma Score was 14 on arrival but it is steadily declining.
• He desaturates rapidly with supine positioning. How will you secure his airway?

A 27-year-old woman is expected by EMS with severe face, neck, and chest burns secondary to falling into a campfire while intoxicated…

• An experienced EMS crew notifies the ED before arrival that they failed 2 attempts to intubate by video laryngoscopy and are ventilating by bag valve mask; her oxygen saturation is 89% on 100% oxygen.
• They are coming to your non–trauma-designated community ED as they anticipate imminent loss of her airway.
• ETA is 4 minutes. How do you prepare?

A 32-year-old man presents to the ED with a self-inflicted knife wound across his anterior neck...

• He cut himself deeply with a hunting knife before being apprehended by police.
• EMS reports he is maintaining his airway.
• What are your initial concerns regarding possible injuries? What might your airway stabilization options be?

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