The indications for an emergency surgical airway are several; however, the majority are due to an inability to establish an orotracheal or nasopharyngeal airway. This may be due to anatomy (short, obese neck), a disease state (epiglottis, laryngeal edema, paralyzed vocal cords, or retropharyngeal abscess), trauma from distortion of the neck by hematoma (cervical fracture or major vessel injury), aspiration of blood (facial trauma), or loss of supporting structures (mandibular fractures). Clinical manifestations of acute airway obstruction are stridor (in a patient who is still able to breath) or cyanosis. Clinical signs and symptoms are listed in Table 16-1.
TABLE 16-1 Clinical Manifestations Associated with Acute Airway Obstruction
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