ABC of major trauma. Management of the upper airway.

All severely injured patients have hypoxaemia in varying degrees. As soon as medical help arrives the first priority must be to ensure that the patient's airway is free and ventilation is unimpaired. Immediate administration of Indications for securing an airway supplementary oxygen to the unobstructed airway is of paramount with an endotracheal tube importance. Remember that in the first vital minutes the cervical spine of * Apnoea any patient with trauma should be considered broken until proved * Obstruction of upper airway otherwise. The neck must be kept stabilised without traction (for example * Protection of lower airway from soiling by using a spine board, sand bags, or a hard collar) at all times until the with blood or vomitus possibility of neck injury is excluded. * Respiratory insufficiency * Impending or potential compromise of In an unconscious patient any obstruction to the airway must be removed airway (prophylactic intubation)-for under direct vision. The laryngeal and pharyngeal reflexes should then be example, after facial burns or continuous assessed and respiratory performance examined. If protective reflexes are seizures after Intravenous diazepam . aisd . intracrnips reqin adequate-for example, the patient is coughing-retracting the tongue hyperventilation foward by employing the chin lift or jaw thrust manoeuvre or inserting an anaesthetic type airway or nasopharyngeal tube may suffice. If the reflexes are depressed or absent-that is, there is no gag reflex when oropharyngeal suction is attempted in an unconscious patient-the airway must be secured at the earliest opportunity by intubation with an appropriately sized endotracheal tube with a low pressure cuff.