This patient, involved in motor-vehicle accident was referred from a district hospital with an oral airway in situ. His upper lip was badly lacerated and swollen.
His initial GCS when admitted to us was 5/15.
His breathing was stridorous.
I would have preferred that this patient's airway be secured properly through endotracheal intubation before transfer.
Airway management is of paramount importance in cases of maxillofacial injuries such as this case.
This is because
1. The maxillofacial injuries causes swelling and distortion of the face, thus obstructing the airway for the patient and making access to airway difficult to the emergency physician
2. The bleeding can be profuse, like in this case and coupled with the fact that patient may sustain head injuries together, his conscious level is poor (in this case, the GCS on admission was 5/15) and a very high chance of aspiration
3. In the case that the patient sustain mandibular fracture resulting in a flail mandible, resulting in the loss of support for the tongue. The tongue can fall backwards and obstruct the airway.
4. Other loose structures, like loose dentures or teeth can also obstruct the airway.
Cases like this, almost always, or should I say, all of these cases require aggressive airway management including early endotracheal intubation. Of course, at the same time this should alert us of difficult airways.
For further reading:
An excellent, short and sweet article can be downloaded free (in *.pdf) from EMJ online (past issues). Click here
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