الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Airway management is the single most important skill taught to and possessed by emergency physicians. It represents the “A” of the mnemonic ABC (Airway, Breathing, Circulation), which forms the foundation for the resuscitation of critically ill and injured patients. Airway management encompasses the assessment, establishment and protection of the airway in combination with effective oxygenation and ventilation. Timely effective airway management can mean the difference between life and death, and takes precedence over all other clinical considerations with the sole exception of immediate defibrillation of the patient in cardiac arrest due to ventricular fibrillation.
The purpose of this study was to evaluate the techniques of airway management that were used in the critically injured patients admitted to the Alexandria Main University hospital and their outcome during a period of 6 months starting from July the 31st 2007 through January the 31st 2008.
The present study included 219 patients who were divided into four groups according to the intubation attempts:
• Group A: The universal airway group who were sedated or undergo Rapid Sequence Induction (RSI) to be intubated successfully. This group included 174 patients.
• Group B: The difficult airway group. This group included 3 patients.
• Group C: The crash airway group who were completely unresponsive or near death. This group included 42 patients.
• Group D: The failed airway group who couldn`t be intubated regardless whether they could be ventillated or not. No cases were reported.
The following data were recorded for all patients:
History taking.
Personal data.
The mechanism of trauma.
Clinical assessment.
Indication of definitive airway management.
Technique of intubation.
Number of intubation trials.
The use of sedatives and NMBAs.
Immediate and long term complications of airway management.
Arterial blood gases findings and other diagnostic investigations.
The outcome.
RTA was the major mechanism of injury representing 76.7% followed by falls from a height (18.3%), falling of heavy objects on the head, assault and gun shot. Males within the productive age group were the commonly injured. Direct orotracheal intubation was the most commonly used method to secure airway in the critically injured patients (99.5%). The commonest indication of intubation was GCS ≤ 8 (92.7%). The percentage of patients who were intubated without sedation was 56.2% and it was found that 75.3% of patients intubated from the first attempt with 100% success rate.
Hypotension and desaturation were the most common immediate complications of intubation followed by vomiting, cardiac arrest, dental loss and right main stem bronchus intubation. Obstruction of the endotracheal tube or the tracheostomy tube was the most frequent long term local complication during the hospital stay.
Forty eight patients (21.9%) of the study population were successfully extubated, 15.5% were tracheostomised and 54.3% died with ETT in place.
Surgical technique for tracheostomy tube insertion was the most commonly used technique which accounted for 94.1%. Most of the tracheostomised patients (85.3%) developed local complications in the form of; obstruction 70.6%, tracheoesophageal fistula 2.9%. The tracheostomy tubes were successfully closed in 29.4% of the tracheostomised patients and 18 cases (52.9%) died with T.T in place.
Death rate among those patients who were in need for definitive airway management was 64.8%. This represented the major outcome in the study population.
The use of RSI during endotracheal intubation of head trauma patients should be expanded. Rocuronium should be used instead of other NMBAs in RSI for intubation due to its lower side effects. Better care for the ETT and T.T should be given to prevent their obstruction. Emergency medicine physicians should be supplied with more monitors and difficult airway kit to improve their performance.