The main advantages of the Combitube in elective and emergency surgery are higher insertion and ventilation rates, reliable protection of the airway against regurgitation and aspiration of gastric contents e. Agreement on type of device, adequate system-wide training on its use and subsequent quality review to ensure that it is used with proper indications and quality controls remain both barriers and requirements for effective implementation or system-wide change:. Since the time for achieving airway control before onset of dangerous levels of hypoxemia is critical, preoxygenation is crucial and is to be carried out as much as possible, using a nonrebreathing mask. Submental and retromolar intubation maintain oral and nasal access while simultaneously avoiding tracheostomy. Intracranial malposition of nasopharyngeal airway. Trauma of the larynx and trachea may cause swelling and displacement of structures, such as the epiglottis, arytenoid cartilages, and vocal cords, thereby increasing the risk of cervical airway obstruction.
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Fatal case of tension pneumothorax and subcutaneous emphysema after open surgical tracheostomy. A continuous glow accompanies tracheal intubation, whereas a brief interruption and subsequent recovery indicates esophageal intubation. Additionally, the attending physicians should become familiar with all details of the trauma and identify the difficulties involved in order to choose the best approach for managing the patient's airway [ 29 , 30 ]. Approach to the Airway of the Patient with Maxillofacial Trauma 4. Knowledge of this may facilitate subsequent location of the larynx for endotracheal intubation.
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CALS Manual - Acute Care 3 Rapid Sequence Intubation Algorithm Rescue AirwaysML

In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. Prepare for endotracheal intubation. Maxillofacial trauma: A potentially fatal injury. Recurred pneumocephalus in a head trauma patient following positive pressure mask ventilation during induction of anesthesia -A case report. Despite these rare case reports, some authors continue to advocate blind nasotracheal intubation in patients with skull base fractures.
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Patient head position can be neutral. I'm an anesthesiologist and paramedic. Management of the difficult airway in the trauma patient. The Combitube elective anesthetic airway management in a patient with cervical spine fracture. Providers prefer the LMA. The choice of an airway device that will be used during the operation is to be agreed upon by the surgeon who is familiar with the planned procedure, including possible intraoperative change of plan and potential postoperative complications.
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Combitube facial trauma

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