EMERGENCY AIRWAY MANAGEMENT

The American Society of Anesthesiologists (ASA) difficult airway management algorithm^[11] is a useful starting point for the trauma anesthesiologist, whether in the ED or the OR (also see Chapter 42 ). Although the options included will vary from institution to institution and provider to provider, the concept of the algorithm is an important one; the anesthesiologist should have a plan in mind for both the initial approach and for coping with any difficulties that might develop. Figure 63-3 is a typical algorithm for emergency intubation in an unstable trauma patient. Note that it differs from the ASA algorithm in that reawakening the patient is seldom an option because the need for emergency airway control will presumably remain.

Indications

The goal of emergency airway management is to ensure adequate oxygenation and ventilation while protecting the patient from the risks of aspiration and airway obstruction.

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Figure 63-2 Surgical priorities in trauma patients. (Redrawn from Dutton RP, Scalea TM, Aarabi B: Prioritizing surgical needs in the patient with multiple injuries. Probl Anesth 13:311, 2001.)

Figure 63-3 Emergency airway management algorithm used at the R. Adams Cowley Shock Trauma Center, presented as an example. Individual practitioners and trauma hospitals should determine their own algorithm based on available skills and resources. LMA, laryngeal mask airway.

• Cardiac or respiratory arrest

• Respiratory insufficiency (see Table 63-1 )

• Airway protection

• The need for deep sedation or analgesia, up to and including general anesthesia

• Transient hyperventilation of patients with space-occupying intracranial lesions and evidence of increased intracranial pressure (ICP)

• Delivery of 100% FIO₂ to patients with carbon monoxide poisoning

• Facilitation of the diagnostic workup in uncooperative or intoxicated patients