**6. Airway control in emergency situations**

The securing of a patent airway for maxillofacial trauma patients in emergency situations whether inside or outside the hospital carries a considerable risk of failure and death due to airway obstruction. An additional risk is added when most of those patients are managed by inexperienced medical staff. This was shown in a study where there was 97% of trauma patients who were managed by unexperienced physicians in airway management. Most maxillofacial trauma patients who are acutely desaturating are intubated via orotracheal route by direct laryngoscopy [32].


Aintree intubation catheter (Cook Medical, Bloomington, IN, USA) permits intubating patients via any LMA (sizes 3,4,5) with ETT 6–8 mm ID without interruption of oxygenation [34].

Despite weak reports, blind endotracheal intubation (ETI) with blind use of either gum elastic bougie or tube exchange catheter is not advisable in critically ill patients as it's associated with tracheal injury and has been the cause for positive pressure ventilation-related pneumomediastinum.

**61**

*Airway Trauma: Assessment and Management DOI: http://dx.doi.org/10.5772/intechopen.96894*

3.The double lumen airway (Combitube, Tyco Healthcare Group LP, Pleasanton, CA or the laryngeal tube and also known as the King LT (VBM Medizintechnik, Sulz, Germany)), is a dual lumen tube, with dual cuff that is blindly inserted into the oesophagus (**Figure 7**). The distal balloon is smaller and inflated within the oesophagus to prevent gastric reflux. The proximal one is a larger balloon which seals off the oropharynx and allows ventilation via perforations between the two cuffs [35, 36]. This tube is always inserted by paramedics at the scene due to ease of insertion

4.Finally, the cricothyroidotomy is indicated in failed attempts at intubation or

Other reported indications include airway obstruction by excessive emesis or haemorrhage, known cervical spine fracture, and inability to visualize the

Cricothyroidotomy was reported in 0.4% of emergent airway control patients in total of 8320 trauma admissions [39], and in 0.1–3.3% of patients with maxillofacial trauma [40]. Other studies showed that 15–23% of emergent cricothyroidotomies was used as the first and only means of airway control [41, 42].

Scalpel cricothyroidotomy is the rapid and most suitable method of securing the airway in the emergency situation. A cuffed endotracheal tube in the trachea prevents the airway from aspiration, provides a secure route for expiration, permits low-pressure ventilation using traditional breathing systems and allows end-tidal CO2 monitoring. A number of surgical techniques have been described, but there is a lack of evidence of the superiority of one over another. The techniques all have common steps in general: neck extension, identification of the cricothyroid membrane, cutting through the skin and

in comparison of endotracheal intubation [37].

ventilation [32].

*The intubating laryngeal mask airway.*

**Figure 5.**

vocal cords [38].

**6.1 Scalpel cricothyroidotomy**

*Special Considerations in Human Airway Management*

skin to secure position (**Figure 4**).

**Figure 4.**

*Submental intubation.*

laryngoscopy [32].

submandibular gland and/or its duct [30, 31].

**6. Airway control in emergency situations**

interruption of oxygenation [34].

A reinforced, armored, endotracheal tube is used in this technique, in order to prevent the tube from kinking during its usage. After a regular orotracheal intubation, the tube is passed by blunt dissection through the floor of the mouth at halfway between the chin and the angel of the mandible, and then sutured to the

Complications from submental endotracheal intubation include bleeding, damage to the lingual and mandibular branch of the facial nerve and damage to the

The securing of a patent airway for maxillofacial trauma patients in emergency

situations whether inside or outside the hospital carries a considerable risk of failure and death due to airway obstruction. An additional risk is added when most of those patients are managed by inexperienced medical staff. This was shown in a study where there was 97% of trauma patients who were managed by unexperienced physicians in airway management. Most maxillofacial trauma patients who are acutely desaturating are intubated via orotracheal route by direct

1.Additional choices for managing the emergent airway include the Fastrach intubating laryngeal mask airway (ILMA Fastrach) (**Figure 5**), placed blindly through the mouth to seals off the hypopharynx via a circumferential inflat-

2.Intubation through LMA using Aintree exchange catheter (**Figure 6**).

Aintree intubation catheter (Cook Medical, Bloomington, IN, USA) permits intubating patients via any LMA (sizes 3,4,5) with ETT 6–8 mm ID without

Despite weak reports, blind endotracheal intubation (ETI) with blind use of either gum elastic bougie or tube exchange catheter is not advisable in critically ill patients as it's associated with tracheal injury and has been the cause for

able cuff; this may prevent aspiration of blood [32, 33].

positive pressure ventilation-related pneumomediastinum.

**60**

**Figure 5.** *The intubating laryngeal mask airway.*

3.The double lumen airway (Combitube, Tyco Healthcare Group LP, Pleasanton, CA or the laryngeal tube and also known as the King LT (VBM Medizintechnik, Sulz, Germany)), is a dual lumen tube, with dual cuff that is blindly inserted into the oesophagus (**Figure 7**). The distal balloon is smaller and inflated within the oesophagus to prevent gastric reflux. The proximal one is a larger balloon which seals off the oropharynx and allows ventilation via perforations between the two cuffs [35, 36].

This tube is always inserted by paramedics at the scene due to ease of insertion in comparison of endotracheal intubation [37].

4.Finally, the cricothyroidotomy is indicated in failed attempts at intubation or ventilation [32].

Other reported indications include airway obstruction by excessive emesis or haemorrhage, known cervical spine fracture, and inability to visualize the vocal cords [38].

Cricothyroidotomy was reported in 0.4% of emergent airway control patients in total of 8320 trauma admissions [39], and in 0.1–3.3% of patients with maxillofacial trauma [40]. Other studies showed that 15–23% of emergent cricothyroidotomies was used as the first and only means of airway control [41, 42].
