52.1 The general method for airway obstruction

If a patient survives his original injury, the next hazard that he has to overcome is obstruction to his airway. Making sure that he can breathe must thus be your your first priority. He is in particular danger if: (1) He is unconscious from a head injury (63.1) which depresses his cough reflex and causes him to lose control of his tongue and jaw. (2) His face, mouth, mandible, or neck has been injured (62.1). (3) His face or his respiratory tract has been burnt (58.27). (4) Rarely, his larynx or trachea may be injured (52.4). The most important single measure in preventing airway obstruction is to make sure that a patient is transported in the recovery position (51-2). After this, the next methods are those which are also used to prevent obstruction during anaesthesia. These are described in Section 4.2 of Primary Anaesthesia, and are shown in Fig. 52-1. Most of them are quick, and if one does not succeed, try the next one rapidly. The earlier ones are almost always enough. If they fail, and a patient is conscious or partly conscious, try ‘awake intubation’. This is safe, it will not unduely distress him, and it is not practised as often as it should be. Laryngotomy and tracheostomy are rarely needed, but, when a patient does need them, he needs them urgently to save his life. You should find yourself intubating patients frequently, but doing a laryngotomy or tracheostomy only rarely. They are diffcult to manage.