Many unexpected symptoms can stem from common traumas and accidents, and individuals often suffer significant airway damage from traumatic events. Around the world, injuries such as car accidents, gunshot wounds, and concussions account for more than 3 million non-fatal injuries annually. These common trauma scenarios can happen to anyone.
Causes and Types of Physical Trauma
Physical trauma refers to any serious injury to the body. The two types are blunt force trauma, which occurs when an object or force strikes the body, often resulting in concussions, deep cuts, or broken bones, and penetrating trauma, which happens when an object pierces the skin or body, usually creating an open wound.
Traumatic injuries are more serious than everyday cuts, bruises, or scrapes. They often require admission to the hospital for assessment, treatment, and rehabilitation, and sometimes warrant operations within the first few days of injury. Patients with severe injuries sometimes require intensive care, specialist treatments, or transfers to additional hospitals.
How Trauma Damages the Airway
Airway function can be rapidly compromised by physical trauma, and once compromised, the severity of the damage can escalate rapidly when a patient suffers trauma to their neck, such as blunt laryngeal trauma. They may quickly require emergency intubation or a surgical airway to help them breathe and manage symptoms of stridor or wheezing. The severity of damage from laryngeal trauma can range from minor vocal cord weakness to fractures of the cartilage structures of the larynx and trachea.
When laryngeal or tracheal fractures occur from trauma, they can lead to the escape of air into the neck and chest, resulting in significant respiratory compromise and sometimes fatal consequences if not addressed carefully and efficiently.
After suffering blunt trauma, severely injured patients can develop airway obstruction or poor ventilation, leading to hypoxia or death within minutes.
The LEMON Assessment Method
When conducting airway assessments of patients in a difficult situation who have suffered physical trauma, providers must perform pre-intubation checks to determine the difficulty of intubation and the status of the patient’s basic neurologic functions. The LEMON assessment tool mnemonic is helpful for providers to reference when conducting airway assessments. LEMON stands for:
L: Look for visual signals that the airway may prove difficult, such as a broken jaw or loose dental structures. Difficulties also may occur if the patient is obese, has a high arched palate, a short neck, or trauma to the face and neck.
E: Evaluate the airway with the 3-3-2 guideline. The mouth should be three fingers wide from top to bottom when open; so too should the space from the hyoid bone to the chin. The area between the thyroid notch and the hyoid bone should be a minimum of two fingers wide.
M: Mallampati score the airway. A high score increases the likelihood of a difficult airway. If the posterior pharynx can be fully exposed, the airway is a 1. A class 2 denotes a partially exposed pharynx. Class 3 means that the posterior pharynx cannot be exposed, but the base of the uvula is visible. Class 4 airways are the most challenging, with no visible posterior structures.
O: Look for airway obstruction, or possible sources of obstruction such as broken teeth.
N: Neck mobility. A patient who is unable to fully move their neck faces a higher risk of injury.
The symptoms of physical trauma vary from patient to patient, and so does the impact of trauma on patients’ airway health and functions. To remain prepared for a diverse range of trauma and airway management scenarios, providers must continue to familiarize themselves with different types of trauma and their damage to the airway, and the importance of a portable suction device. Read this blog to learn more about trauma and airway management.
Editor's note: This blog was originally from October 2023. It has been re-published with additional up-to-date content.
