- Airway compromise from TBI comes in many forms.
Unconscious head injured patients may lose muscle tone in their jaw, and their tongue may obstruct the airway. The gag reflex may also be compromised in TBI patients, which increases the risk of aspiration from vomit or blood. Clenched teeth, known as trismus, is another common finding that makes position and suctioning airway secretions difficult. Attempt to open the airway with a jaw thrust. Use an oral or nasal airway if the patient will tolerate it, position the patient on their left side to help prevent aspiration, and suction secretions.
Endotracheal intubation is the definitive airway management for TBI, often after sedation and paralysis with RSI. This procedure carries considerable risk, and whether it should be done by ground EMS crews is controversial. Remember that the goal for airway management should be to use the least invasive means to maintain a clear path for oxygenation and ventilation.