Protection of respiratory integrity and haemodynamic stabilization

Objectives: To perform an analysis of the protection of respiratory integrity and haemodynamic stabilization based on the literature review and the experiences and perspectives of emergency and ENT specialists. Methodology: A comprehensive literature search was undertaken through PubMed and MEDLINE, using the following keywords: [protection of the respiratory integrity], [intubation], [hypotension] and [haemodynamic stabilization]. Articles were selected if the topic was relevant to current ENT and emergency practice. Additional articles were identified through a careful review of reference lists in Uptodate. A critical review of ENT and emergency specialists was carried out. Evidence staging and recommendation levels were established using the Paul Shekelle scale. Results : Firstly, protection of the airway is necessary before starting haemodynamic stabilization. Fibre-optic examination and laryngeal intubation form the gold standard of diagnosis and treatment in the protection of the airway. For circulation, a short catheter with a large size allows the management of intravenous fluids, with vasopressors if necessary. Aetiologic and specific treatments are also very important. Conclusions : Appropriate and collaborative management is necessary with the "ABCDE" approach: Airway and immobilization of the neck; Breathing; Circulation; Disability and Exposure. A fibre-optic examination is the gold standard of airway diagnosis. Laryngeal intubation is the most effective treatment for protection of the respiratory integrity. The management of circulation includes the implementation of a venous route to initiate administration of IVFs, preferably with isotonic saline. Vasopressors and inotropes are used as second line agents. A multidisciplinary and team approach is preferred, in order to achieve diagnosis and therapeutics simultaneously

Tracheal damage.

Tracheal damage. Blunt/penetrating trauma and inhalation injuries to the trachea can result in acute airway compromise, with life-threatening implications. Early assessment, identification, and prompt and appropriate management are of paramount importance in order to reduce patient morbidity and mortality. Signs and symptoms of these injuries are specific and sometimes subtle, and their seriousness may be obscured by other injuries. Diagnosis can therefore be challenging, requiring a high index of suspicion. Indeed, diagnosis and treatment are often delayed, resulting in attempted surgical repair months or even years after injury. Laryngoscopy, flexible and/or rigid bronchoscopy and computed tomography of the chest are the procedures of choice for a definitive diagnosis. Airway control and appropriate ventilation represent the key aspects of emergency management. Definitive treatment depends on the site and the extent of injury. Surgery, involving primary repair with direct suture or resection and end-to-end anastomosis, is the treatment of choice for patients suffering from tracheal injuries. A conservative approach must be considered for the paediatric population and selected patients with mainly iatrogenic damage. We present a review of the incidence, mechanisms of injury, clinical presentations, diagnosis, initial airway management, anaesthetic considerations and definitive treatment in the case of tracheal damage from blunt/penetrating trauma and inhalation injuries