Fast Track Surgery: Trauma, Orthopaedics and the ... - PasTest

Chapter 4: The trauma call in orthopaedicsWhat types of injuriescompromise the airway?How is the airway evaluated?3. Open mouth/odontoid peg view –picks up 99% of injuries whenused with above viewsFurther management is based onfindings and includesflexion-extension views and CTscanning.Two main groups:1. Facial/neck trauma: stabwounds to the neck, facial traumapost-assault or unrestrainedpassengers in head-on collisions,causing oropharyngeal loosebodies/haematoma/bruising2. Head injury with low GCS andimpaired laryngeal/pharyngealreflexes: GCS < 8 withimpaired cough or gag refleximplies inability to self protect theairway against aspiration ofvomit/blood. The airway musttherefore be cleared and securedAsk a simple question. A lucidresponse in a normal voice impliesan intact airway with no laryngealcompromise. If no response:Look: for any misting of the oxygenmask, facial trauma, blood or foreignbodies in the oropharynx and signs ofany ventilatory obstruction, such astracheal tug, see-saw breathing(abdominal retraction on inspirationwith no chest movement) orcomplete apnoea/cyanosisListen: for signs of air movement,cough reflex and evidence of upperairway obstruction such as:• Stridor (hoarse inspiratory soundcaused by extrathoracic largeairway obstruction)• Gurgling27PART II