As recently as the mid-1980s, Advanced Trauma Life Support (ATLS) advocated blind nasotracheal intubation as the preferred method of definitively controlling the airway in trauma patients without contraindications because of concern about cervical spine movement. The first priority in stabilization starts with assessment and management of the airway.

However, major trauma can occur anywhere, so all emergency departments must be able to provide initial stabilization of the sick trauma patient. In the United States, the care of trauma patients has evolved into specialized, regional trauma centers. An emergency clinician must have a strategy for these situations based on clinical skills, available devices, urgency of the situation, and potential consultants, if any. Although these patients will most often eventually be transferred to a trauma center, a difficult or failed airway initially can present to any emergency department, and can be extremely challenging. After a brief review of the history of airway management in trauma patients, this article will discuss the literature concerning several difficult clinical scenarios. EMERGENCY AIRWAY MANAGEMENT: A TARGETED REVIEW OF DIFFICULT TRAUMA SITUATIONSĪirway management is one of the cornerstones of emergency medicine practice and resuscitation.

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