It was the third vehicle crash of the shift. The first two were minor – low-speed fender benders with minor injuries. This one was different: a high-speed impact involving an unrestrained driver. The facial injuries were extensive.
The patient was semi-conscious, but breathing on his own. A C-collar was in place, but the patient was trapped by the steering wheel. He had copious amounts of blood streaming from his nose and mouth. His front teeth had been obliterated by the steering wheel. He began to cough and choke. His airway was obviously in trouble. What to do?
Patients with dental trauma pose significant challenges, especially when they present with possible head injuries. Nasotracheal intubation is out of the question, contraindicated by facial and skull fractures. Oral intubation will be challenging because in this case, the patient was entrapped with extensive trauma to the mouth. Your only alternative in such cases is to rely on your portable suction unit.
Let’s look at the critical role of a portable suction machine when treating patients with dental trauma.
Throughout your lifetime, you will go through two sets of teeth. The deciduous, or baby, teeth begin erupting during the first year of life and are replaced as you age by the permanent teeth. There are 20 deciduous teeth—10 on top, 10 on the bottom. As the permanent teeth erupt, they shove the baby teeth out of the jaws, which is why your deciduous teeth fall out. The permanent teeth total 32: 16 on top, 16 on the bottom. And although teeth are the hardest substances in the body, they can still be broken.
The categories of dental trauma include:
Although the classifications matter little to the rescuer in the field, facial trauma can have serious implications for airway management. Broken and loose teeth pose several threats. They include:
In extreme cases of dental trauma, continuous suction, while monitoring the patient’s oxygenation and 02 saturation, may be the only option for maintaining airway patency. Effective suction can achieve:
Before preparing the patient with dental trauma for suction, you must first prepare your equipment. Equipment prep includes:
Once your equipment is ready, prep your patient. The extent of dental trauma will determine your approach. Preparation includes:
Trauma patients are always a challenge, and when trauma involves dentition, it can pose a significant risk of airway obstruction. Treatment must be tailored to the patient, based on the extent of injuries and the number of teeth involved. Your portable suction machine will play a critical role in managing the airways of patients with dental trauma.
Editor's Note: This blog was originally published in November, 2017. It has been re-published with additional up to date content.