Airway and breathing support

Key steps

Consider intubation in patients whose airway is at risk

Patients who are not breathing will have been intubated and ventilated as emergency interventions following the primary survey. Consider intubation also in the following high-risk situations: 

• Stridor is an immediate indication for intubation. 
• Increasing swelling of the head and neck 
• Altered consciousness and/or unable to protect the airway 
• GCS<9 
• Uncooperative/combative/disoriented patient 
• ‘Prophylactic’ intubation if there is significant or reasonable doubt regarding airway patency during transfer. This is particularly important in cases of long transfer times or transfer delays. 

*Note:  

• Capnography MUST be available to assess the placement of the endotracheal tube in the trachea. 
• Ongoing ETCO2 monitoring should inform the assessment of ventilation adequacy. 
• Patients who have undergone anaesthesia and ventilation have a greater risk of hypothermia and efforts should be made to minimise heat loss. 

Administer 100% high flow (15 L/min)

• Administer 100% high flow (15 L/min) humidified oxygen via a mask or endotracheal tube. 
• Oxygen post-intubation/ventilation should be guided by blood gases. 
• Oxygen therapy is fundamental in patients with suspected inhalation injury or cyanide poisoning, and assists with overall organ oxygenation and tissue perfusion. 

Sit the patient up

• Sit the patient up if possible to minimise airway oedema. 

Consider chest escharotomy in circumferential chest burns

• Escharotomy is a high-risk procedure and should only be performed after consultation and advice from the appropriate Burn Service. 

Frequent reassessment

• Swelling requires frequent reassessment of airway patency and breathing over time, particularly if not intubated