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Emergency airway management in the adult with direct airway trauma

Trevor J Mills, MD, MPH
Peter DeBlieux, MD
Section Editor
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Airway management in patients who have sustained direct trauma to the airway is among the most challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway obstruction.

Immediate, definitive airway management is needed when the patient cannot protect their airway or is unable to adequately oxygenate or ventilate. Emergent or urgent airway management is indicated when a patient develops respiratory distress or when symptoms are progressing rapidly. In addition, airway management often is indicated when the patient appears clinically stable, but the clinician anticipates clinical decline (eg, smoke inhalation, edema, subcutaneous air, hematoma) or feels that an unprotected airway presents a risk to the patient who requires transport to another facility or to radiology for extensive diagnostic studies. The higher rate of complicated airways in this population mandates that the clinician be prepared to use advanced airway techniques, including a surgical airway.

Airway assessment and management in adults with direct airway trauma will be reviewed here. Other aspects of airway management, including a general approach to the difficult airway, the decision to intubate, and advanced tools for airway management, are discussed separately. (See "Approach to the difficult airway in adults outside the operating room" and "Rapid sequence intubation for adults outside the operating room" and "Devices for difficult emergency airway management outside the operating room in adults" and "The decision to intubate" and "Basic airway management in adults".)

The general management of trauma to the head and neck is also discussed separately. (See "Initial evaluation and management of facial trauma in adults" and "Penetrating neck injuries: Initial evaluation and management" and "Skull fractures in adults".)


Common causes of direct airway trauma include the following:

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Literature review current through: Nov 2017. | This topic last updated: May 02, 2017.
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