Airway management in polytrauma scenario is highly challenging and requiring special challenges. This presentation covers basic, advanced skills, airway assessment in trauma scenario, special challenges, and management pearls.

1. Airway
Management in
Polytrauma :
Advanced
version
Dr. Venugopalan P P, DA,DNB,MNAMS,MEM(GW)
Director and Lead consultant in Emergency
Medicine
Aster DM Healthcare ,India

2. Background
Prevention of hypoxemia requires a protected, unobstructed airway
and adequate ventilation, which take priority over management of all
other conditions.

3. This session...
1. Define definitive airway.
2. Recognize the signs and symptoms of airway
obstruction and ventilatory compromise.
3. Describe the techniques for establishing and
maintaining a patent airway.
4. Describe techniques for confirming the adequacy of
ventilation and oxygenation
5. Explore the management pearls in specifice trauma
scenarios

4. What are the Priorities in Polytrauma?
1. Airway and C-Spine
protection
2. Breathing and Ventilation
3. Circulation and Hemorrhage
control
4. Disability
5. Exposure and prevention of
hypothermia
A
B
C
D
E

5. Case scenario
● 34-year-old motorcyclist lost
control and crashed into a fence
● Obvious facial trauma
● No helmet
● Smells of alcohol
● Belligerent at scene; now not
communicating
● Pulse oximeter 85% Airway
management

6. Airway assessment
How do I know the airway is adequate?
Airway
management

7. How do I know the airway is adequate?
• Patient is alert and oriented.
• Patient is talking normally.
• There is no evidence of injury to
the head or neck.
• You have assessed and
re-assessed for deterioration
Airway
Assessment

8. Signs and symptoms of airway
compromise
• High index of suspicion
• Change in voice / sore throat
• Noisy breathing (snoring and
stridor)
• Dyspnea and agitation
Airway
Assessment

9. Signs and symptoms of airway
compromise
• Tachypnea
• Abnormal breathing pattern
• Low oxygen saturation (late
sign)
Airway
Assessment

10. Remember ….
● Agitated patient
● Rule out Hypoxia
● Obtunded patient
● Rule out Hypercarbia
Airway
management

11. When to intervene in a patient with a
patent airway?
1. Airway problem - Impending airway
compromise
2. Breathing problem-Need for ventilation
3. Circulatory Problem-Intractable shock
4. Disability problem-Inability to protect the
airway, Low GCS
5. Expected course : Transfer to Radiology , Transfer to
another Institution
Airway Assessment
A
B
C
D
E

12. Dynamic Airway - Anticipatory Intubation
● Bullet
● Burn
● Bites
3 B’s in
Head &
Neck
Airway
management

13. How do I manage the airway of a trauma
patient?
• Supplemental
oxygen
• Basic techniques
• Basic adjuncts Airway
management

14. When to intervene in a patient with a
patent airway?
Definitive airway
• Cuffed tube in the trachea
Airway
Management

15. When to intervene in a patient with a
patent airway?
Difficult airway adjuncts
• Unexpected difficult
airway
• Predicted difficult
airway Airway
management

16. Protect the cervical spine during airway
management!
Airway Management

17. Cervical spine motion restriction
Airway
management

18. Cervical collars
Airway management

19. Basic Techniques
Chin Lift Head tilt
Airway
Management

20. Basic techniques
Airway
Management
Jaw thrust

21. Cervical collar with Jaw thrust
Airway
Management

22. Basic Adjuncts
1. Oropharyngeal
Airway - OPA
2. Nasopharyngeal
Airway -NPA
Airway
Management

23. OPA - Use correct size
● Patients who can tolerate an
oral airway will usually need
intubation
● Buying time in emergency
room
● Too large and Too small
cause airway obstruction
Airway Management

24. OPA Insertion
Airway Management

25. Nasopharyngeal
Airway
● Use correct size
● Better tolerated
● Use most patent nose
● Avoid in midfacial
injuries
● Avoid in fracture base
of skull
Airway
Management

26. No NPA
Airway Management
Raccoon’s
Eye
Battle's sign
Midfacial
fracture

27. NPA insertion
Airway Management

28. How do I predict a potentially difficult
airway?
Airway
Management

29. Assess the difficulty at 4 level
Airway
Management
1. Difficulty for Bag Mask
ventilation
2. Difficulty for Intubation
3. Difficulty for Supraglottic
/Extraglottic airway
Insertion
4. Difficulty for Surgical Airway

30. Bag Mask Ventilation
Airway Management
MOANS

31. Difficult airway
BMV
Trauma Related
difficulty
Approach
Limited Jaw thrust Mandibular fracture Early use of SGA
Poor seal Facial injuries with swelling
, Disruption
Early use of SGA
Blood and Vomitus Facial injuries, Full
stomach
Delayed gastric emptying
2 suction/ SALAD
approach
FONA
Penetrating or Blunt trauma
neck
Distorting subcutaneous
emphysema,Disrupted
airway
Passive oxygen
delivery/minimize Positive
pressure ventilation

32. ● SALAD - Suction Assisted
Laryngoscopy & Airway
Decontamination
● FONA-Front Of Neck
Airway
Airway Management

33. SALAD : Suction Assisted Laryngoscopy
Airway Decontamination
● Use rigid large-bore suction to
initially decontaminate
● Perform laryngoscopy keeping
blade superior against tongue
away from fluid
● Advance suction tip into upper
esophagus then wedge in place to
left of the laryngoscope

34. SALAD : Suction Assisted Laryngoscopy
Airway Decontamination
● Use second suction as needed
● Rotate laryngoscope blade 30
degrees to the left to open blade
channel
● Place endotracheal tube (ETT),
inflate the cuff

35. Direct Laryngoscopy
Airway Management

36. Emergency perspective of LEMON
● Look externally
● Evaluate 3- 3-2 rule
● Mallampati score
● Obstruction
● Neck mobility
Unresponsive patients - You
can’t do Mallampati
LEONAirway
Management

37. Trauma perspective of LEMON
● Look externally
● Evaluate 3- 3-2
rule
● Mallampati score
● Obstruction
● Neck mobility
Suspected C spine injury :
U cant Do neck mobility
LEO

38. Difficult airway
DL Scopy
Trauma Related
Difficulty
Approach
Limited Mouth opening/
Jaw displacement
Collar/Improper MILS/
Trismus
Open collar/ Ear Muff MILS
Inability to position MILS BURP/GEB/VL
Blood and Vomitus Facial injuries, Full stomach
Delayed gastric emptying
2 suction/ SALAD
approach
FONA
Penetrating or Blunt trauma
neck
Disrupted /Distorted airway Awake primary flexible
fibero-scopic intubation,VL
assisted intubation

39. Ear Muff MILS Airway Management

40. Extraglottic Device
Insertion
Airway
Management
RODS

41. Difficult airway Trauma Related
Difficulty
Approach
Blood and Vomitus Facial injuries, Full
stomach
Delayed gastric emptying
2 suction/ SALAD
approach
FONA
Penetrating or Blunt
trauma neck
Disrupted /Distorted airway Direct visualization
FIE/FONA, Low
tracheotomy
Airway Management
Extraglottic airway

42. Surgical Airway
Airway
Management
SMART

43. Difficult airway Trauma Related
Difficulty
Approach
Penetrating or Blunt
trauma neck
Distorted/disrupted
airway CTM not
accessible or injury at or
below CTM
Low tracheotomy
Airway Management
FONA

44. Airway
Management
● Is this a difficult airway?
● How would you manage this
patient?

45. What is meant by a Definitive Airway?
A definitive airway is a tube placed in
the trachea with the cuff inflated below
the vocal cords, the tube connected to
some form of oxygen-enriched
assisted ventilation, and the airway
secured in place with tape
Airway Management

46. Definitive Airway - Easy
• Oral intubation (medication
assisted)
• BURP, suction back-up
• Maintain c-spine immobilization
Anticipate difficult airway
Airway
Management

47. Rapid Sequence Intubation /Delayed Sequence
Intubation
Airway
Management

48. ● Is this a difficult
airway?
● How would you
manage this patient?
Airway
Management

49. Definitive Airway - Difficult ?
• Get help
• Be prepared
• Rapid sequence vs.
awake intubation
• Maintain c-spine
immobilization
Airway Management

50. Definitive Airway - Difficult ?
Using Paralytic Agents
for Intubation will be
suicidal
Airway Management

51. Definitive Airway - Difficult ?
• Consider use of:
• Gum elastic bougie
• Combitube
• King’s Airway
• (Intubating) LMA
• Surgical airway
• Other advanced
techniques
Airway Management

52. Gum Elastic bougie assisted intubation
Airway Management

53. Definitive Airway - Difficult ?
Rescue airway devices - Buying time
Airway Management

54. Rescue airway devices- Buying time
Intubating LMA
Airway Management

55. Definitive Airway - Difficult ?
Video Laryngoscopy is a
choice
● Difficult airway
● Unstable C-spine injury
● Blood in oral cavity ???
Airway Management

56. Video Laryngoscopes : Types
Macintosh video laryngoscope
-standard geometry blade
● C-MAC (Mac Blade; Karl Storz, Tuttlingen,
Germany)
● McGrath Mac (Mac blade; Medtronic,
Minneapolis, MN)
● GlideScope Titanium Mac (GlideScope,
Verathon, WA),
● Venner APA (Mac blade; Venner Medical,
Singapore, Republic of Singapore).

57. Video Laryngoscopes: Types
Hyperangulated VL (also known
as indirect VL)
● C-MAC (D-Blade)
● McGrath Mac (X blade) standard
GlideScope
● King Vision (non channeled blade Ambu,
Ballerup, Denmark)
Data from Kovacs G, Law JA. Lights camera action: redirecting videolaryngoscopy. EMCrit. 2016. Available at:
https://emcrit.org/blogpost/redirecting-videolaryngoscopy/. Accessed February 25, 2017

58. Video Laryngoscopes: Types
Channeled blade VL
● King Vision
● Pentax AWS (Pentax, Tokyo, Japan)
● Airtraq (Teleflex Medical, Wayne, PA) for
example, King Vision, Pentax AWS
(Pentax, Tokyo, Japan)
Data from Kovacs G, Law JA. Lights camera action: redirecting videolaryngoscopy. EMCrit. 2016. Available
at: https://emcrit.org/blogpost/redirecting-videolaryngoscopy/. Accessed February 25, 2017

59. Definitive Airway - Difficult ?
Superior Laryngeal nerve block
Awake Intubation

60. Definitive Airway - Difficult ?
RSAI

61. Definitive Airway: Surgical Airway
Cricothyroidotomy
Needle- Buying time Surgical- Definitive
Airway Management

62. Airway Management: Surgical Cric

63. Airway Management: Surgical Cric

64. Pediatrics ?
Airway Management

65. How do I know the tube is in the
right place?
Airway Management

66. Confirmation of tube positions
• Visualize it going through the cords
• Watch the chest
• Auscultation
• CO2
detector / ETCO2
monitor
• Pulse oximeter
• X-ray
Airway Management

67. ETCO2 : Colorimetric /Digital /Waveform
Airway Management

68. USG to confirm tube position
Airway Management

69. Esophageal Detector Device / EDD
Airway Management

70. Pulse oximeter/ X Ray Chest in Tube
positioning
Airway Management

71. Pulse-Ox lag
“By the time peripheral oxygen
saturation begins to fall, cerebral
hypoxemia has already occurred, a
phenomenon known as “pulse-ox
lag”

72. Airway
Management
PaO2 Levels SpO2
90 mm of Hg 100%
60 mm of Hg 90%
30 mm of Hg 60%
27 mm of Hg 50%
Approximate PaO2
vs SpO2 Relations

73. Gold standard :
Fiber Optic
confirmation,
Visualization of
tracheal rings
Airway Management

74. Pearls in Trauma
airway
management

75. Focussed
Management Pearls
1. Traumatic brain injury
2. Unstable C Spine
injuries
3. Contaminated Airway
4. Agitated trauma patient
5. Faciomaxillary injuries
6. Laryngotracheal injuries
7. Hemodynamic instability

76. Patients with TBI
● Hypoxemia and Hypotension during airway
management significantly worsens outcomes
in patients with TBI
● Airway management for airway protection
should proceed only after adequate measures
have been taken to prevent intubation
related physiologic disturbances.

77. Patients with TBI
● Postintubation hypocapnia is associated with
poor outcomes in patients with TBI and often
the result of adrenaline induced overzealous
postintubation ventilation
● Postinjury apnea requiring ventilation
support does not necessarily predict poor
outcome.

78. ❏ What are points to be taken care in airway
management in patient with Traumatic brain
injury?
● Avoid Hypoxia
● Avoid Hypotension
● Avoid airway Obstruction
● Pre Oxygenation
● Pre Treatment :
Lignocaine/Opioid/Defasciculating
agents
● Pre load : Fluid
Pre-Intubation

79. ❏ What are points to be taken care in airway
management in patient with Traumatic brain
injury?
DURING
INTUBATION
● Appropriate selection of Drugs
● Use brain friendly agents
● Adequate reflex obtundation
● Do gentle laryngoscopy
● Use adjuncts appropriately
● Expert help as needed
● Avoid hyperventilation

80. ❏ What are points to be taken care in airway
management in patient with Traumatic brain
injury?
1. Avoid coughing ,bucking and Gagging
2. Avoid Tube bitting and Blockage
3. Avoid High PEEP
4. Avoid High PIP
5. Avoid Hyperventilation
6. Avoid Hypoventilation
7. Adequate sedation
8. Adequate paralysis
9. Avoid Jugular obstruction (C-Collar, ETT
tieng tap)
10. Always check DOPE
Post Intubation
Ten As

81. Management
pearls
Unstable C Spine injuries

82. Patient with Unstable C spine injuries
● Imaging should not delay airway
management and assume all trauma
patients have unstable cervical spines.
● Optimally use the intubation device he
or she is most experienced with.
● Be prepared for a poor view with direct
laryngoscopy (DL) and always have a
bougie ready for use.

83. Patient with Unstable C spine injuries
● Rigid cervical collars must be
opened or removed and replaced by
properly applied manual inline
stabilization (MILS).
● Properly applied MILS should avoid
immobilization of the mandible.

84. Patient with Unstable C spine injuries
● Use a hyperangulated
video laryngoscope, a
deliberate restricted glottic
view may facilitate difficult
ETT advancement

85. Management
pearls
Contaminated
airway

86. Patient with contaminated Airway
● Have at least 2 large-bore rigid suction catheters.
● Consider alternative options for hemorrhage control
(sutures, packing, epistaxis kit).
● Minimize positive-pressure ventilation (PPV) and
use a mono meter for provider feedback when mask
ventilation is indicated.
● Look for epiglottis as an important landmark for
glottis and have a bougie prepared for use with DL

87. Patient with contaminated Airway
● VL is considered the best option, Macintosh VL may be
the preferred device, as it may be used directly if
contamination obstructs camera
● Consider esophageal ETT diversion connected to
suction
● Suction-assisted laryngoscopy airway decontamination
(SALAD) approach
● If intubation fails and patient is desaturating, front of
neck airway (FONA) rescue oxygenation approach is
indicated

88. Agitated
trauma
patients
Management pearls

89. ● Agitation may be a symptom of traumatic pathology
● Agitated patients may require facilitated cooperation to
ensure adequate preoxygenation
● Ketamine is an appropriate agent to facilitate cooperation
in agitated patients in preparation for airway management
● Always be prepared to provide definitive airway
intervention before administering sedation.
Agitated Trauma patients

90. Faciomaxillary
trauma
Management pearls

91. Patients with Faciomaxillary Trauma
● Do careful assessment of damaged
anatomy recognizing the unique airway
complications associated with facial
fractures.
● Both laryngoscopy and mask
ventilation may be challenging
● Double set-up should be prepared for
when rapid sequence intubation (RSI) is
the chosen approach

92. Patients with Faciomaxillary Trauma
● An awake approach, although not
always practical, should be considered.
● Management of aggressive bleeding
should be anticipated.
● Allow patients to assume a position
of comfort when safe to do so.

94. Management pearls
Laryngo-Tracheal injuries

95. Patients with Primary Airway injury : Laryngo
tracheal trauma
● Decompensation in the patient with a
traumatized airway may be rapid and
catastrophic.
● PPV should be avoided if possible.
● An awake approach with appropriate
topicalization is the preferred approach.
● If an RSI is chosen, a double set-up with a
FONA plan for accessing the trachea based
on the level of the airway breach.

96. Patients with Primary Airway injury : Laryngo
tracheal trauma
● ETT placement should ideally be
performed with visualization of the airway
using a flexible intubating endoscope
(FIE).
● Advanced techniques using FIE either
primarily in an awake patient or assisted
by VL when an RSI is chosen are
recommended when resources and skill
are available.

98. Management pearls
Hemodynamic instability

99. Peri Intubation hemodynamic instability
● Resuscitation using blood products (packed red
blood cells/massive transfusion) should be done
early in the pre-intubation phase of trauma
management
● Selected scenarios consider the use of
vasopressors during the peri-intubation phase.
● Reduce the dose of all induction agents by at
least 50% and increase the dose of the
paralytic agents

100. Management pearls
Pre-Oxygenation
“The rule of two”

101. PreOxygenation : “The Rule of Two”
● Elevate the Head (ear to sternum) and the Bed
greater than 20 (reverse Trendelenburg).
● Two sources of oxygen for all critically ill patients
1. High-flow nasal prongs !15 L/min
2. NRB/bag-mask ventilation !15 L/min.
● Two approaches for obstruction: OPA with a Jaw
thrust for soft tissue obstruction

102. PreOxygenation : “The Rule of Two”
● Two attachments for your BVM: positive
end-expiratory pressure valve and pressure
manometer
● Two hands on all face masks: to ensure closed
system oxygenation and ventilation and perform
an aggressive jaw thrust
● Two providers: a tight mask seal and
aggressive jaw thrust giving feedback to the
provider squeezing the bag
● Avoid over ventilation and hyperventilation

103. Trauma-
Airway
Management
Checklists

104. Pre Intubation
checklist
One
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Team Ready ?
❏ EP Aware / Experienced airway
staff present
❏ Do we need additional help?
❏ Assign roles: Lead /
MILS/BVM/Drugs/ETI
Trauma -Airway
Management

105. Pre Intubation
checklist
Two
Trauma -Airway
Management
Patient Ready ?
❏ Monitor(Pulse OX,ECG,BP,EtCO2)
❏ Reverse Trendelenburg 30 degree
❏ Ramp if obese
Dual pre Oxygenation
❏ Nasal Cannula@15+LPM AND
❏ NRBM@15 flush LPM or If Sats
less than 96%
❏ BVM/PEEP 5-10 cm(Passive)
❏ NIV
Fluid bolus
Pressor support ( Consider if SI more
than .8)
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

106. Pre Intubation
checklist
Three
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Equipment ready?
❏ BVM with PEEP/Pressure
manometer
❏ DL/Mac VL, Stylet 30-40 degree +
Bougie
❏ HA-VL ETT stylet 60-70 degree
❏ Suction (1-2)
❏ SGA sized
❏ Bougie cric equip available
❏ Ventilator/RT support
Trauma -Airway
Management

107. Intubation checklist One
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Airway assessment & Plan
❏ Estimated Level of Difficulty
Laryngoscopy/BMV/SA/Surgical
(Circle ) Low,Moderate,High,Very
High
❏ Consider Dangerous Physiology
Low BP/Low Sat/Low pH,RV Strain
❏ RSI vs Awake approach,
❏ Medications
-RSI Induction/NMBA doses
-Awake, Ligno 4% or 10% spray
-Ketamine
-Post intubation Sedation
Trauma -Airway
Management

108. Intubation checklist Two
Plan A-B- C- D
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
❏ Plan A - Primary - DL,Mac
VL+ Bougie pr HA -VL
❏ Plan B - ReOx/w ETI
OPA/2 Hand BVM
❏ Plan C Alternative ETI
approach
❏ Plan D - Rescue Ox
SGA/ bougie cric
Trauma -Airway
Management

109. Intubation checklist Three
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Intubation
❏ Time out - ‘’All ready?” “Give
drugs”
❏ Post RSI meds 45 sec
countdown
❏ Passive BVM+Vent prn
❏ Prob solve ETT advancement
-ETT turn left over bougie
-Stylet with VL ETT turn right
❏ EtCO2(Waveform)
Trauma -Airway Management

110. Post Intubation
checklist
One
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Post Intubation
❏ Continuous Waveform
Capnography
❏ Cycle pressures q3min
❏ Sedation/Analgesia orders
❏ Consider ongoing NMBA
❏ OG Tube placement prn
❏ CXR
❏ Restraints Prn
❏ Review ventilator settings
Trauma -Airway Management

111. Post Intubation
checklist
Two
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Debrief
1) What went
well?------------------------------------------
------------------------
2) What could be strengthened and
How?-----------------------------------------
----------------------------
Trauma -Airway Management

112. Post Intubation
checklist
Three
Emerg Med Clin N Am 36 (2018) 61–84
https://doi.org/10.1016/j.emc.2017.08.006 emed.theclinics.com 0733-8627/18/a 2017 The Authors. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Difficulty Rating (Post intubation)-
(Circle)Low, Moderate , *High , *Very
High
*For “High and Very High” Difficulty
Ratings
❏ Directly communicate to CC staff
❏ Document on chart
What made the Airway
difficult?----------------------------------
------------------------------------------
Trauma -Airway Management

113. Trauma -Airway Management

115. Be prepared
● Oxygen
● Suction
● OPA
● NPA
● GEB
● LMA
● Combitude
● Kings
Airway
● Needle &
Surgical
Cric set
● VL
● ETT
different
sizes
● Pulse Ox
● ETCO2
● Drugs
Help
Trauma -Airway Management

116. Pre Oxygenate
O2 +/-, OPA +/-, NPA =/-
Able to Oxygenate ? No
Definitive airway
/Surgical Airway
Yes
Assess Airway Anatomy, Predict
Ease of Intubation( LEMON)
Easy
Difficult
Trauma -Airway
Management

117. Intubation/-, Drug assisted
intubation,Cricoid pressure
Call for assistance
Unsuccessful
Consider Adjuncts( LMA, Kings
Airway,GEB)
Consider Awake
Intubation
Definitive Airway/ Surgical Airway
Trauma -Airway Management

119. drvenugopalpp@gmail.com, 9847054747
www.drvenu.blogspot.in