MANAGEMENT OF AIRWAY IN ACUTE HEAD INJURY

IN SPITE of the remarkable advances made in the emergency management and definitive treatment of the injured, critical analysis of reported series still reveals a high mortality rate among those patients who are seriously hurt. We could correctly assume that there are morphologic and physiologic limits to the extent of injury which are compatible with recovery; generally and specifically, these would be difficult to delineate. However, it would seem that with a large mortality, there could be some room for improvement. In particular, the past decade has witnessed an increased emphasis on the maintenance of a patent airway in the treatment of all types of trauma. With respect to cases of head injury, this is certainly one aspect which deserves further consideration.

Respiratory obstruction with resultant asphyxia has two components¹: first, a reduced pulmonary ventilation capacity evidenced clinically as dyspnea; and second, hypoventilation. The latter produces hypercapnia (increased circulating