Not attempting intubation was a good idea. Would have been difficult and
could have killed the patient if you'd failed. Vascular access: Long
saphenous cut down at the groin takes seconds and I've never seen one fail
(Technique described with pictures in J Trauma a few years back). Lot easier
than cut downs on arms (bigger vein, floating around in loose CT so easy to
see) or blind stabs at deep veins. Midface fractures are a problem if you
lay the patient supine. Airway obstructs, patient thrashes around as they
feel (correctly) that you are trying to suffocate them. In first world war,
patients with big midface injuries were carried face down on the stretcher.
Alternative is letting the patient sit upright- risks to the spine, but
depends on how likely you feel the spine to be injured and whether you feel
the risks are outweighed by those of respitory compromise with at best
avoidable; and at worst failed intubation. BVM and airways just don't work
in these cases. A judgement call (medicolegally safer to keep the patient on
their bak nad go for intubation, though)
Matt Dunn
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