Synopsis
Recognise a failing traumatic airway, maintain oxygenation while limiting spinal movement, deliver a planned definitive airway, and confirm continuously that ventilation remains effective.
- Ask the patient to speak while observing work of breathing; a clear answer supports current patency but does not predict whether swelling, bleeding or fatigue will worsen.
- Open with jaw thrust, suction under direct vision and remove visible loose material; use an oropharyngeal airway only without a gag reflex and a nasopharyngeal airway cautiously when midface or skull-base injury is suspected.
- Give high-concentration oxygen during critical illness, pre-oxygenate with the best tolerated technique and preserve spontaneous ventilation until the definitive plan is ready when anatomy is concerning.
Key red flags
Stridor, gurgling, inability to speak, expanding neck swelling, severe facial disruption, soot or progressive hoarseness indicates a threatened airway requiring early expert control.
Investigation priorities
Confirm and continuously monitor tracheal ventilation.
Identify clinically significant fracture or instability.
Management branches
Noisy, obstructed or inadequately ventilated traumatic airway.
- Call for anaesthetic and trauma help, maintain manual in-line stabilisation, apply jaw thrust and clear blood, vomit or visible foreign material with effective suction.
- Give high-concentration oxygen and use correctly sized airway adjuncts; assist ventilation with a two-person bag-mask technique if spontaneous breathing is inadequate.
The tube and physiology are currently stable enough for imaging or definitive care.
Key medicines
Medical oxygenIn critical trauma, start high-concentration oxygen through a reservoir mask at 15 litres per minute or deliver 100% oxygen during assisted ventilation, then titrate once reliable monitoring and physiology permit.