Major Trauma Principles

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Major Trauma Principles

A = airway and cervical spine protection

  • 4 minutes to establish patent airway before cerebral infarction begins

Spotting a restricted airway:

  •  Stridor, voice changes/hoarseness

  • Agitation - from hypoxia

Risks

  • Unconscious patient at risk of swallowing tongue.

  • Risk of secretions - vomit, blood

  • Laryngeal oedema - anaphylaxis, epiglotitis, trauma, smoke inhalation/burns

  • Direct trauma to larynx

Airway Adjuncts

 Gudels airway

  • Prevent unconscious patient swallowing airway (size by measuring middle lip to angle of jaw)

Rebreathing bag

  • will increase inspired oxygenation to ~90%

Nasal tongues

Nasopharyngeal tubes

  • lubricate with KY jelly

  • use safety pin to prevent insertion too far

  • use right nostril as turbinates bulge to left

  • measure tip of nose to tragus of ear

Contra-indications

  • ·         Severe facial injury

  • ·         Skull base fracture or cribriform plate

Definitive airways

Cricothyroidectomy

Tracheostomy

Complications

  • Bleeding

  • Stenosis (if damage to 1st tracheal ring)

Endotracheal Tube

  • 32cm ♀

  • 36cm ♂

  • Need to sedate patient: stimulate gag reflex or laryngeal spasm

  • Cuffed tube prevents aspiration of gastric contents

  • Wide enough to pass suction tube

  • Need:

    • Yanker Sucker

    • Magills Forceps

    • Laryngoscope

    • Tape

    • Syringe

  • Connect to Ambubag or ventilator

B = breathing & oxygenation

C = circulation & haemorrhage

D = disability & neurological state

E = Exposure & environment

 

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