SAQs on this topic are relatively recent. Question 7.2 from the first paper of 2010 offers a photograph of a teenager who clearly has some sort of neck injury, and gives his history as "ran his motorbike into a single strand of fencing wire". The young man looks like he has been garotted, and presents with stridor. The candidates were asked to manage the stridor, and (as a separate question) to secure the airway. Something similar, but much more detailed, was asked in Question 12 from the first paper of 2021. Question 24 from the first paper of 2013 is more about the pros and cons of different approaches to the patient with traumatic airway distortion due to facial injuries.
As far as published literature goes, the UpToDate article ("Emergency airway management in the adult with direct airway trauma") is an excellent resource for the paying customer. If one has institutional access, one may be able to acquire one excellent article from Anesthesiology by Jain et al (2016). Both of these sources were boiled drained and compressed into the summary below.
Obviously. this is not something that can be protocolised, as each specific scenario will be different. The main thing to remember is that delay is an option. A review by Kummer et al (2007) found that approximately 30% of the patients had their definitive airway established in the operating theatre, demonstrating that it is occasionally safe to wait. Nothing particularly fancy was done in OT - of those patients about half were intubated conventionally, though the mouth with direct laryngoscopy.
This is a group of patients for whom conventional oral or nasal intubation may not be an option. Question 24 from the first paper of 2013 presents such a patient. They have a mobile mid-face, noisy breathing, facial swelling, and they insist on sitting up to a 90° angle. Possible injuries in this group are listed below, along with the way in which they complicate management:
Dental trauma
Temporo-mandibular trauma
Maxillary trauma
General issues to consider:
Thankfully, this is rare (the trachea is well defended by the thoracic inlet and ribcage). Things to consider:
Penetrating neck injury is discussed in greater detail elsewhere. A case series by Shearer et al (1993) reported that direct laryngoscopy with RSI or a primary surgical airway were the most frequently successful techniques in the management of penetrating neck trauma. Things to consider:
Caron, Guy, et al. "Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures." Journal of Trauma and Acute Care Surgery 48.2 (2000): 235-240.
Barriot, P. A. T. R. I. C. K., and B. R. U. N. O. Riou. "Retrograde technique for tracheal intubation in trauma patients." Critical care medicine 16.7 (1988): 712-713.
Mohan, Raja, Rajiv Iyer, and Seth Thaller. "Airway management in patients with facial trauma." Journal of Craniofacial Surgery 20.1 (2009): 21-23.
Schaefer, Steven D. "Management of acute blunt and penetrating external laryngeal trauma." The Laryngoscope 124.1 (2014): 233-244.
Peady, "Initial Airway Management of Blunt Upper Airway Injuries: A Case Report and Literature Review" Australasian Anaesthesia 2005
Kelly, James P., et al. "Management of airway trauma I: Tracheobronchial injuries." The Annals of thoracic surgery 40.6 (1985): 551-555.
Kelly, James P., et al. "Management of airway trauma II: combined injuries of the trachea and esophagus." The Annals of thoracic surgery 43.2 (1987): 160-163.
Shearer, Vance E., and A. H. Giesecke. "Airway management for patients with penetrating neck trauma: a retrospective study." Anesthesia & Analgesia 77.6 (1993): 1135-1138.
Devitt, J. Hugh, and Bernard R. Boulanger. "Lower airway injuries and anaesthesia." Canadian journal of anaesthesia 43.2 (1996): 148-158.
Jain, Uday, et al. "Management of the Traumatized Airway." The Journal of the American Society of Anesthesiologists 124.1 (2016): 199-206.
Bhojani, Rehal A., et al. "Contemporary assessment of laryngotracheal trauma." The Journal of thoracic and cardiovascular surgery 130.2 (2005): 426-432.
Kummer, Carmen, et al. "A review of traumatic airway injuries: potential implications for airway assessment and management." Injury 38.1 (2007): 27-33.