Trauma-related respiratory emergencies can be some of the most difficult patient scenarios to treat. Trauma comes in many forms: from blunt to penetrating to blast injuries involving any or many parts of the body. And when the trauma affects the respiratory system, whether through direct impact (oral or facial injuries) or indirectly (pneumothorax or hemothorax), your patient can teeter on the brink of survival.
Treating respiratory emergencies is never easy. And when they are compounded by trauma, they can be downright deadly. So, let's discuss what to look for when it comes to trauma-related respiratory emergencies.
Assessing the Trauma Patient
Like any medical emergency, treatment begins with a thorough assessment. Traumatic injuries pose an added emergent factor: time. Your decisions must be quick, your treatments immediate. Any time you are dealing with a serious traumatic injury, you are playing against the clock, because the patient's survival may depend on how quickly he or she gets to surgery. Your initial decisions should include:
- Can the patient protect his or her airway?
- Is the patient achieving adequate oxygenation and ventilation?
- Is this patient a candidate for intubation?
These questions must be answered quickly and confidently.
To assist in answering these crucial questions, here are a few follow-ups:
- What is the patient's GCS? If the patient has a low GCS, he or she will certainly be unable to protect his or her airway.
- Does the patient have a gag reflex? This will dictate the type of airway intervention to follow.
- Does the patient need supplemental oxygen? Don't hesitate to apply O2 and consider high flow via a non-rebreather in the presence of trauma.
With traumatic injuries, ALWAYS consider cervical spine immobilization. Although your first priority is the airway, be sure to protect the patient's spine by applying early immobilization (manually or via a collar) and secure the patient to a backboard when applicable.
Preparing to Intubate
If the patient's condition warrants intubation, here are a few questions you should ask yourself:
- Do I have all the necessary equipment? This will include:
- Bag-valve mask
- Intubation supplies (tubes, stylet, syringe)
- Suction unit—critical!
- Supplemental oxygen
- Will the patient be a difficult intubation? Indicators include:
- Short, thick neck
- Small oral cavity
- Facial trauma
- Cervical immobilization
- Is the patient a candidate for RSI? Indicators include:
- Intact gag reflex
- Clenching jaw
Trauma-related respiratory emergencies can be complicated affairs. But if you know what to look for, you can expedite an effective treatment and get that patient where he or she needs to be: a trauma center. Every second counts, so be quick, be thorough, and be decisive.
Horton, CL, CA Brown, and AS Raja
Trauma Airway Management, The Journal of Emergency Medicine, 2014:46(6):814-820,