11/16/2023 0 Comments Causes of a le fort fractureIt is also best to secure the airway early when the extent of injuries or their likely course is unknown. It is prudent to secure the airway early in patients exhibiting any signs or symptoms listed above, as they are at high risk for rapid deterioration. However, in some patients with facial fractures, BMV may improve the situation as the face mask may act as a splint to stabilize the fractures. In patients with facial fractures, extreme care must be taken with BMV as it may displace facial bone fragments, worsen airway obstruction, and worsen subcutaneous emphysema, pneumocephalus, pneumomediastinum, and pneumothorax.This is followed by basic maneuvers such as suction, chin lift, jaw thrust, oral airway placement, and BMV if these procedures are not contraindicated based on the mechanism of injury. Initially, 100% oxygen is administered, and the airway is cleared of debris such as dentures, loose teeth, tissue, blood, and vomitus.Airway disruption or distortion due to swelling or hematomas can cause normal anatomical relationships to be obscured and make cricothyrotomy difficult as well.Maxillofacial injuries may limit mouth opening or present with debris such as teeth or bone fragments in the oropharynx and make the use of rescue devices such as laryngeal mask airways difficult to impossible.It is essential to have effective suction available to clear bleeding and debris that may obscure the glottic view during laryngoscopy. Laryngoscopy and intubation are likely to be extremely difficult when there is significant bleeding or disruption of normal anatomy.Airway obstruction from heavy bleeding, soft tissue swelling or hematoma from maxillofacial injuries, and subcutaneous emphysema can also cause difficulty with bag-mask ventilation. Severe maxillofacial injuries that disrupt bones and create instability in the middle or lower face make it difficult to maintain a proper mask seal and cause difficulty with bag-mask ventilation (BMV).Similarly, patients with bleeding into the oropharynx or nasopharynx and a fluctuation or worsening level of consciousness are also at high risk of progressing to an unstable and potentially difficult airway. Patients with unstable mandible or midface injuries may appear stable initially but are at a high risk of progressing to an unstable and potentially difficult airway.The trauma and anesthesiology teams must also be vigilant for signs of developing airway compromise, such as severe bleeding in the oropharynx or nasopharynx, crepitus in the neck or chest, hematoma in the neck or lower face, hoarseness or changes in voice, subjective sense of dyspnea despite adequate oxygen saturation.Indirect signs of airway compromise include drooling, trismus, odynophagia, tracheal deviation or anatomical abnormality of the larynx or trachea.Direct signs of airway compromise include dyspnea and stridor.
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