A 40 year old man who met with a motor vehicle catastrophe came to the casualty hospital in an hour with severe maxillofacial trauma. His Pulse rate was 120/min, BP was 100/70 mm Hg, Sp02 -80% with oxygen. What would be the immediate management
Correct Answer: Orotracheal intubation
Description: Orotracheal intubation Patients with severe maxillofacial trauma and with low Sp02 even on oxygen suggests severe airway compromise or obstruction. In these cases emergency airway management is essential. The patient require immediate oxygen. - These patients needs to be intubated immediately. - But an impoant point to note is that severe maxillofacial trauma makes intubation very difficult. -Some believe that nasotracheal intubation is contraindicated in patients with severe maxillofacial injury because nasotracheal intubation in these patients can result in nasocranial intubation or severe nasal hemorrhage. - Nasotracheal intubation is absolutely contraindicated in patients with midfacial injury and C.S.F. rhinorrhoea. Orotracheal intubation in patients with severe maxillofacial injury In patients with severe maxillofacial injuries orotracheal intubation is also difficult. Presence of blood clots, .fractures make the passage of the tube quite difficult. Moreover when the surgeons perform operation for mandibular or maxillary fractures they wires both these together. If surgery is required with severe maxillofacial injury surgeons usually prefer nasotracheal intubation or tracheostomy. Tracheostomy in patient with severe maxillofacial injury : ? Tracheostomy does not have much role in "emergency airways management". - Tracheostomy is a time taking procedure compared to intubation. - If the airways of the patient is severely compromised and he requires immediate oxygenation, tracheostomy has no role. - Immediate oxygenation can only be delivered by rapid intubation. In case, intubation is impossible, cricothyroidotomy is an alternative. -In emergency management of the airway, cricothyroidotomy is done if intubation is not possible. Tracheostomy is only done when immediate oxygen requirements are taken care of and a surgical procedure is planned. In the question the Sp02 of the patient is 80% when on oxygen. He requires immediate emergency management of the airway which can be achieved through intubation, If intubation is impossible, cricothyroidotomy is an alternative. The better option of intubation in this patient is orotracheal intubation. The ideal management in this patient is cricothyroidotomy. Since that is not mentioned in the question intubation in the next best option. "Orotracheal intubation would be preferred over nasotracheal intubation in these cases"
Category:
Anaesthesia
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