Thyroid & Adrenal
a. The first step in evaluating an acutely injured patient assesses the need for resuscitation. As taught throughout basic life support training, remember the ABCs (ie, airway, breathing, circulation).
b. An initial attempt to establish an airway might employ chin lift or jaw thrust positional maneuvers; however, take care to avoid hyperextending the neck because this may injure the spinal cord in patients with cervical spine fractures.
c. An oropharyngeal airway and clearing the airway of foreign bodies may also assist in ventilating the patient.
a. In the unconscious patient, the first step usually is orotracheal intubation. Perform this step with the neck in a neutral position because cervical spine injury is always a possibility.
b. A lateral cervical spine radiograph is essential to evaluate the patient's condition but should not delay securing the airway of a patient in distress.
c. Attempts at orotracheal intubation in patients with significant laryngeal trauma often are ill advised. Additionally, extensive maxillofacial injury may require a surgical airway. In this case, the preferred emergency airway technique is a cricothyroidotomy.
d. Nasotracheal intubation is not generally recommended in the patient in acute respiratory distress or in patients with extensive maxillofacial trauma because the procedure requires both time and a stable mid face.
e. Other controversial techniques include needle cricothyroidotomy with jet insufflation for temporary airway management or percutaneous tracheostomy.
f. If possible, for children younger than 12 years, ATLS training recommends needle cricothyroidotomy over surgical cricothyroidotomy for temporary airway control to avoid the long-term sequelae of cricoid cartilage damage specific to the pediatric population.