Clinical Pathways
Clinical Pathways
Soft Signs of Airway Compromise
Soft Signs of Airway Compromise

Soft Signs of Airway Compromise

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Decision

Soft signs of airway compromise?

Progressive neck swelling, change in voice, nonenlarging hematoma, blood in airway, vascular bruit, need for transfer.

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Yes → Consider intubation or re-evaluate patient frequently; Perform CTA neck (Class I)

Background

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Intubation for Patients With Mouth and Neck Trauma

For patients with a propensity for worsening airway edema, early intubation is critical. As with all intubations, preoxygenation and a difficult airway algorithm are necessary. Maintain cervical spine precautions if there is concern for spinal injury (although this is uncommon). Video laryngoscopy is useful for patients with limited mouth opening but this may be limited by vomitus or blood that can obstruct the camera.54^{54} Options to mitigate this include leading with large-bore suction, use of a bougie, or direct laryngoscopy with inline cervical stabilization. Cricothyrotomy may ultimately be necessary if intubation is unsuccessful (including an expert attempt), but care should be taken if injury obstructs or deforms the cricothyroid membrane.

Imaging

For a patient who has any penetrating injury to the neck that violates the platysma, a CTA of the neck should be obtained to evaluate for the scope of injury.51,52^{51,52} This is particularly true when there is concern for arterial or aerodigestive injuries. If a hemodynamically stable patient is being evaluated at a facility that is not a trauma center, imaging should not be performed if it will delay transfer. Early operative exploration is indicated for patients with hard signs of airway compromise.

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References
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No Soft Signs of Airway Compromise
No Soft Signs of Airway Compromise
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