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A surgical cricothyroidotomy with insertion of a cuffed tracheal tube provides the only safe, protected airway for this patient. Needle cricothyroidotomy will aid oxygenation and, to a lesser extent, ventilation, but does not secure the airway with a cuff and allows aspiration of the blood and debris in the oropharynx. Needle cricothyroidotomy should be considered a temporary, life-saving manoeuver for oxygenation when a personnel skilled in surgical airways are not available.. |
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Although the patient is breathing spontaneously, blind nasal intubation is contra-indicated due to the presence of severe facial and possible base of skull injuries. In addition this technique can worsen nasopharyngeal and oropharyngeal haemorrhage and lead to a disastrous airway situation.