Trauma airway management

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Maintenance of a patent and secured airway is essential to the management of trauma, and requires physicians experienced with airway control techniques. Trauma-setting airway control problems can be caused by vital failures, risk of aspiration, potential for cervical spine injury, combative patients, and the obvious risk of difficult tracheal intubation related to the specific injury of the patient. Endotracheal intubation remains the gold standard in airway management for trauma patients, and should be performed via the oral route, with a rapid sequence induction and a manual in-line stabilization maneuver, to circumvent some of the problems previously mentioned. In this paper different techniques to control the airway in trauma patients are discussed, including lighted stylet tracheal intubation, improvement of the laryngoscopic vision, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube, and cricothyroidotomy. Airway management in trauma patients requires regular training in these techniques, and knowledge of complementary techniques that allow tracheal intubation or oxygenation to overcome difficult intubation is vitally important.

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