Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
ABCDE of trauma
Airway management
Airway management techniques
Ventilation (breathing) management
Circulatory management
Circulatory resuscitation measures
Secondary surgery
Chest trauma
Abdominal trauma
Head trauma
Spinal trauma
Neurological trauma
Limb trauma
Special trauma cases
Transport of critically ill patients
Trauma response
Activation plan for trauma team
Primary Trauma Care Manual | Airway management techniques
 

 

BASIC TECHNIQUES

Chin lift and jaw thrust

To perform a chin lift, place two fingers under the mandible and gently lift upward to bring the chin anterior. During this manoeuvre, be careful not to
hyperextend the neck. Care should be given to neck stabilization, if appropriate.

The jaw thrust is performed by manually elevating the angles of the mandible to obtain the same effect.

Remember these are not definitive procedures and obstruction may occur at any time.

Oropharyngeal airway

Insert the oral airway into the mouth behind the tongue; it is usually inserted upside down until the palate is encountered and is then rotated 180 degrees. Take particular care in children because of the possibility of soft tissue damage.

Nasopharyngeal airway
Insert a nasopharyngeal airway (well lubricated) via a nostril and pass it into the posterior oropharynx. It is well tolerated.

ADVANCED TECHNIQUES

Orotracheal intubation

Uncontrolled laryngoscopy may produce cervical hyperextension. It is essential that in line neck immobilization is maintained by an assistant. Cricoid pressure may be necessary if a full stomach is suspected. Inflate the cuff and check the correct placement of the tube by checking for normal bilateral breath sounds.

Consider tracheal intubation when there is a need to:

:: Establish a patent airway and prevent aspiration
:: Deliver oxygen while not being able to use mask and airway
:: Provide ventilation and prevent hypercarbia.

Tracheal intubation should be performed in no more than 30 seconds. If you are unable to intubate, continue ventilation of the patient via mask.

Remember: patients die from lack of oxygen, not lack of an endotracheal tube (ETT).

Surgical cricothyroidotomy

Surgical cricothyroidotomy should be conducted in any patient where intubation has been attempted twice and failed and/or the patient cannot be ventilated.

Technique

1 Hyperextend the neck, making the patient comfortable.
2 Identify the groove between the cricoid and thyroid cartilages just below the “Adam’s apple” (the protruding thyroid).
3 Clean the area and infiltrate with local anaesthetic.
4 Incise through the skin vertically with a 1.5 cm cut and use blunt dissection to ensure that you can see the membrane between the
thyroid and cricoid (Figure 1).
5 With a #22 or #23 scalpel blade, stab through the membrane into the hollow trachea.
6 Rotate the blade 90° (Figure 2), insert a curved artery forceps alongside the blade, remove the blade and open the forceps side to side, widening the space between the thyroid and cricoid cartilages
(Figure 3).
7 Pass a thin introducer or a nasogastric tube into the trachea if very small access (Figure 4) or proceed to 9.
8 Run a 4–6 endotracheal tube over the introducer and pass it into the trachea (Figure 5).
9 Remove the introducer, if used.


This tube can stay in place for up to 3 days. Do not attempt this procedure in a child under the age of 10 years; passing several needles through the membrane will give enough air entry.

This procedure should be performed by an experienced person, with prior knowledge of the anatomy and medical condition of the patient.

This procedure should not be undertaken bleeding and delay can cause death.

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