Primary Survey Airway Evaluation

1. See Also
   1. Cardiopulmonary Resuscitation
   2. Guidelines for Emergency Cardiovascular Care
   3. Advanced Airway
   4. Intubation
2. Pathophysiology
   1. Tongue most commonly obstructs unconscious patient
3. Evaluation
   1. Signs of impending airway compromise
   2. Evaluate for trauma related airway compromise
      1. Maxillofacial trauma
      2. Neck trauma
      3. Laryngeal trauma
         1. Hoarseness
         2. Subcutaneous Emphysema
4. Management
   1. Assume Cervical Spine Injury
      1. Maintain inline cervical spine stabilization
      2. Consider SCIWORA in pediatric patients
   2. Airway Suction
      1. Blood
      2. Mucus
      3. Dental fragments
   3. Open Airway
      1. Head Tilt-Chin Lift
      2. Jaw Thrust (if Cervical Spine Injury is suspected)
   4. Maintain Airway
      1. Oropharyngeal Airway
      2. Nasopharyngeal Airway
5. Pitfalls: Trauma
   1. See Advanced Airway for intubation indications
      1. Elastic Bougie can simplify intubation of a patient with c-spine immobilization
      2. Video laryngoscopy is also very helpful when neck movement is restricted
   2. Cervical Spine Injury
      1. Immobilize c-spine until definitive spine evaluation with C-Spine CT (instead of Cross Table lateral)
      2. Assistant should provide head down, neck inline c-spine stablization during Primary Survey (instead of cervical collar)
         1. Provides countertraction as the intubating provider lifts Mandible
         2. Assistant can also help keep mouth wide open
      3. Inline c-spine stabilization during intubation may not prevent movement and may increase laryngoscope forces
         1. Santoni (2009) Anesthesiology 110(1): 24-31
         2. Turner (2009) J Trauma 67(1): 61-6
   3. Airway Compromise
      1. Foreign body in airway (e.g. Loose teeth or dentures)
      2. Facial Fracture (Mandibular Fracture, Maxillofacial Fracture)
      3. Tracheal Fracture or Larynx disruption
      4. Blunt supraclavicular trauma
   4. Loss of airway protection
      1. Altered Level of Consciousness
      2. Aspiration of gastric contents
      3. Multisystem trauma
6. References
   1. Trauma
      1. (2008) ATLS Manual, American College of Surgeons
      2. Majoewsky (2012) EMR:RAPC3 2(1): 1-2
   2. Cardiopulmonary Resuscitation Guidelines
      1. http://www.circulationaha.org
      2. (2010) Guidelines for CPR and ECC
      3. (2005) Circulation 112(Suppl 112):IV
      4. (2000) Circulation, 102(Suppl I):86-9