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Review article


BILJANA SHIRGOSKA ; University of Skopje, University Department of Otorhinolaryngology, Anesthesiology Department, Skopje, Macedonia
JANE NETKOVSKI ; University of Skopje, Medical Faculty, University Department of Otorhinolaryngology, ENT Department, Skopje, Macedonia
IGOR KIKERKOV ; University of Skopje, Medical Faculty, Department of Preclinical and Clinical Pharmacology with Toxicology, Skopje, R. Macedonia

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Upper airway trauma patients have to be treated as diffi cult airway patients in pre-hospital and hospital settings. Airway management is included in the prehospital trauma care and advanced trauma care. The aim of this article is to present clinical observations that pertain to airway management in upper airway trauma patients, including clinical approach to traumatized upper airway, diffi culties in airway management in these patients, defi nition of failed airway, algorithm for failed airway, anticipation and decision-making. Clinical approach to upper airway is the fi rst step that clinicians usually do. Traumatized airway is by the book diffi cult airway that does not need the same procedure of prediction that we use evaluating the airway. Diffi culties in airway management in trauma patients include diffi culties in laryngoscopy and intubation, diffi cultbag-mask ventilation and diffi culties in the use of supraglottic devices. In the severely upper airway traumatized patients, a clear defi nition of airway failure is necessary, as well as an action plan to follow when this occurs. According to Diffi cult Airway Society guidelines for management of unanticipated diffi cult intubation in adults, failed airway exists when there have been three failed attempts by an experienced anesthetist, or there has been one failed attempt by an experienced anesthetist combined with inability to maintain adequate oxygen saturation. Repeated attempts of intubation carry the risk of traumatizing the already traumatized upper airway. The time and ability to think clearly are limited in this situation, so airway algorithm can be used in these situations. On the other hand, there are many failed airway algorithms developed by the societies. The most important points in those algorithms are anticipation and decision-making, decision driven by whether there is suffi cient time to consider alternatives. If ‘cannot intubate, cannot oxygenate’ scenario arises, the pathway leads to the front open neck access (FONA). It is perfectly appropriate to attempt rapid placement of laryngeal mask airway (LMA) simultaneously with preparation for FONA. The attempt of LMA placement must not delay the initiation of the defi nitive airway and must be accomplished in parallel with the preparations for FONA. Reasons for diffi cult FONA can be penetrating or blunt neck trauma. Trauma-related diffi culty in these situations is distorted or disrupted airway. Cricothyroid membrane could be accessible or injured. Low tracheotomy is a solution for airway establishing in this situation.


failed airway; upper airway trauma patients

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