A 40 year old man who met with a motor vehicle catastrophe came to the casualty hospital in an hour with severe maxillofacial trauma. His Pulse rate was 120/min, BP was 100170 mm Hg, Sp02 - 80% with oxygen. What would be the immediate management- (AIIMS Nov 10)
Orotracheal intubation [Ref. Morgan's Anaesthesia 4th/ed. p. 112]
a. Patients with severe maxillofacial trauma and with low Sp02 even on oxygen suggests severe airway compromise or obstruction.
b. "Oral tracheal (orotracheal) intubation is recommended in patients with severe maxillofacial injury.
About option a
c. Nasal intubation (nasotracheal intubation) may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain.
About option d "The literature commonly states that patients with "severe facial trauma" should undergo tracheostomy. With modern intubation techniques using jiberoptic assistance, a tracheostomy is rarely necessory.
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