How would you manage this airway?

[MmacFN]

Hey everyone.

Ok. While my environment is different from the OR, this question is still valid.

If you have a patient who:

- had a severe head injury (grey matter visible),

- severe bleeding into the airway, unclearable by suction,

- Difficult to BVM do to severe lower jaw fx/instability and tear in the skin under the mandible. Sat = 78% with bagging

Would you choose to:

- Cric

- Nasal

- Blind attempts

- ILMA/Combitube

- Something else

Would you use any induction agents? Sedation, paralytics etc

- What if the patient had some degree of trismus? Then what?

Thanks

[deepz]

in the OR cric...

in the field, have someone do a chest compression and intubate the bubble.

d

In your circumstances at that time, Mike, a cric was the right thing to do.

However, as gp says, you'll see why (after you've become a CRNA and have done five or ten thousand DLs) 'intubate the blood bubbles' will then be the answer.

Experientia docet.

deepz

[MmacFN]

Hey Deepz

I have used that technique before. It does work and is a valid technique. The only problems in this situation that didnt really allow it was time (pts sat/aspiration in progress) and trismus. Otherwise GP is right, thats exactly how i would manage the airway.

In your circumstances at that time, Mike, a cric was the right thing to do.

However, as gp says, you'll see why (after you've become a CRNA and have done five or ten thousand DLs) 'intubate the blood bubbles' will then be the answer.

Experientia docet.

deepz