Trauma Patients and Airway Assessment Challenges

There are many factors to consider when performing an airway assessment, and some of those factors can present obstacles for all patients and providers involved. Trauma patients require extra care and caution when receiving airway assessments, and substantial research has been done on unique risks for these patients and things providers must keep in mind when treating them.

According to Emergency Medicine Clinics, 20-30% of all emergency room intubations are for trauma patients. A video created by Nicholas Ludmer at UChicago Medicine describes airway assessments for trauma patients, breaking down the Advanced Trauma Life Support (ATLS) Treatment Algorithm into the following alphabetical categories organized from most deadly to least deadly:

• Airway
• Breathing
• Circulation
• Disability
• Exposure

Knowing that airway trauma is the deadliest category prevents responders from missing any injuries. The following checklist can be used when evaluating a trauma patient’s airway and risk factors:

1. Is the airway open?
1. The fastest way to do this is to ask the patient what their name is, and if the patient responds, that reassures the responders that the airway is open.
2. Is the quality of speech abnormal?
1. Listen for gurgling, course or stridor sounds. These are direct indications that the patient may be experiencing airway swelling or impending airway closure.
3. Have you done a visual inspection of the airway?
1. The airway inspection should consist of evaluating the nostrils, nasal cavity, mouth, back of the throat and the structures in the back of the neck.
2. Check for bleeding, vomit or loose teeth that could present airway blockage.
3. Check for anterior neck crepitus. This can be found in patients with swelling around the neck or air that has been released underneath the skin.
4. Feel for any signs of bone fractures or deformity by performing either a chin lift or jaw thrust. According to the National Library of Medicine, a chin lift can be done by placing the thumb underneath the chin and lifting upward, and a jaw thrust can be done by placing the long fingers behind the angle of the mandible and pushing forward and upward.
4. If you find something wrong, you must treat it before moving on to the evaluation of breathing.

The algorithm doesn’t always apply to every patient or airway factor, but it’s a helpful tool in the toolkit for knowing what decisions to make during treatment that could save time and, ultimately, a patient’s life.

The National Library of Medicine explains that the most common causes of death in trauma patients are airway obstruction, respiratory failure, massive hemorrhage and brain injuries. It has also identified the key indicators that someone is suffering from a traumatic injury, with airway obstruction being at the top of the list. The list includes:

• Airway obstruction
• Tension pneumothorax
• Massive internal or external hemorrhage
• Open pneumothorax
• Flail chest
• Cardiac tamponade
• Intracranial bleed
• Increased intracranial pressure

First responders must have compassion and empathy for all their patients, but especially trauma patients who present severe and unique challenges. Likely, the patient has just gone through one of the worst days or events of their life, and they may be extremely distraught and uncooperative. Although this can be frustrating for first responders there to help, it’s important to talk to the patient and explain what techniques you are performing. Reassuring the patient and talking through each step with them can help keep them calm and aid in easing their concerns.