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![]() ![]() Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. 10% of global road accident deaths occur in India. Clinical training is important to increase airway management skills. Ventilation should be monitored continuously with capnography. In a “can-not-ventilate, can-not-intubate” situation an alternative airway should be tried and if unsuccessful because of severe upper airway pathology, a surgical airway should be performed. With an unexpected difficult airway, bag-valve-mask ventilation should be resumed and an alternative supra-glottic airway device inserted. With an expected difficult airway, the patient should be intubated awake. A lesser experienced health-care provider should completely refrain from intubation, optimise oxygenation, fasten hospital transfer and only in extremis ventilate with an alternative supra-glottic airway or a bag-valve-mask device. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. ![]() A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a patient in extremis. An experienced health-care provider may consider prehospital anaesthesia induction. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. In haemodynamically unstable patients, ketamine may be the induction agent of choice. To review anaesthesia in prehospital emergencies and in the emergency room, and to discuss guidelines for anaesthesia indication pre-oxygenation anaesthesia induction and drugs airway management anaesthesia maintenance and monitoring side effects and training.A literature search in the PubMed database was performed and 87 articles were included in this non-systematic review.For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir. ![]()
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