Intubation of the patient while maintaining full spinal precautions requires skill and a high level of teamwork. Apnoea or respiratory failure due to paralysis.Pending airway obstruction: stridor, hoarse voice.Decreased level of consciousness, unprotected airway, an uncooperative/combative patient leading to distress and further risk of injury.Secure the airway if necessary (treat airway obstruction as a medical emergency)Consider early intubation if there are any signs of: Insert an oropharyngeal airway (OPA)/nasopharyngeal airway (NPA) if required. Suction the airway if excessive secretions are noted or if the patient is unable to clear it themselves. (Nasogastric tube insertion is highly recommended although consideration of intubation and inherent airway protection should be considered prior to insertion.) Attempt simple airway manoeuvres if requiredOpen the airway using a chin lift or jaw thrust. High cervical injuries potentiate loss or compromise of both gag and cough responses. Spinal patients are at particular risk of passive regurgitation and subsequent aspiration. Listen for any upper-airway noises and breath sounds. Look for signs of airway obstruction (use of accessory muscles, paradoxical chest movements and see-saw respirations). Assess for airway stabilityAttempt to elicit a response from the patient. Airway with cervical spine protectionEarly and safe airway management in the SCI patient can make a crucial impact to long-‐term patient outcomes and functional deficits. Regular assessment is crucial in SCI trauma patients as developing cord oedema may cause significant changes in neurological function. The goal is to manage any life-threatening conditions and identify any emergent concerns, especially in an SCI patient who may present with other complications of trauma.Īll patients with a mechanism of injury likely to have induced SCI must have an appropriately fitted and sized collar placed and inline immobilisation implemented. Use a systematic approach based on the ABCDE survey to assess and treat acutely ill patients.
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