Airway management: from pre-assessment to intubation. A student ODP's perspective

Airway management is a fundamental skill in the implementation and maintenance of a general anaesthetic. An anaesthetised patient does not have full control over their airway, and without management a partial obstruction or other more serious complication may occur (Griffiths 1999). There are many ways to reduce the risk of complications occurring in the anaesthetic process. These methods can be subdivided into two main categories: prior preparation (Chethan & Hughes 2008) and pre-assessment (Neacsu 2002).

Stepwise airway management in the trauma patient

The importance of establishing and maintaining a patent airway is a well-recognized principle in the resuscitation of all trauma victims. Many currently available guidelines for airway management in trauma patients have been aimed largely at anaesthetists or those with anaesthetic training. Typically they concen trate on either those patients who require intubation, with techniques to use when this fails, or those in whom little intervention beyond facemask oxygen is required. In reality, clinicians with varying degrees of skill will be faced with managing the trauma patient’s airway and many will not be able to safely attempt tracheal intubation. A pragmatic approach to airway assessment and management is presented that recognizes the variation in skills between clinicians. We also suggest that the role of supraglottic airway devices should now be recognized by all clinicians involved with airway management, particularly those not skilled in tracheal intubation and they should become an integral part of airway management.

Anaesthesia in trauma

Trauma patients may need to be anaesthetized at the scene of an accident, in the emergency department or most commonly in the operating theatre. The principles of safe management of anaesthesia in each of these very different environments are discussed along with the common anaesthetic problems encountered and advice on their solution.