A 30-year-old man is brought to the emergency department in respiratory distress following a shotgun wound to the face. There is a possible cervical spine injury. Which is the best way to gain rapid control of the airway?
In a patient with a massive midface injury, cricothyroidotomy or tracheostomy should be performed, depending on the urgency of the need for airway control (Figure below). Cricothyroidotomy can usually be performed more quickly than tracheostomy. Nasotracheal and endotracheal intubation may push blood and debris into the trachea.Cricothyroidotomy is recommended for an emergency surgical airway. Vertical incisions are preferred to avoid injury to the anterior jugular veins, which are located just lateral to the midline. Hemorrhage from these vessels will obscure vision and prolong the procedure. When making an incision in the cricothyroid membrane, the blade of the knife should be angled inferiorly to avoid injury to the vocal cords. A. Heavy silk suture for traction on the thyroid cartilage. B. Insertion of the cricothyroid tube.
Nasotracheal intubation
Percutaneous jet ventilation
Cricothyroidotomy
Endotracheal intubation
Trauma