Serious facial injuries can block the airway with blood, broken teeth, swelling or a loose jaw that lets the tongue fall back. Early suction, good positioning and a plan for a definitive airway are lifesaving.
Key symptoms
- Bleeding from the mouth or nose
- Trouble breathing or speaking
- Unable to swallow; drooling
- Facial pain, swelling or a changed bite
What you find on exam
- Airway: blood, teeth, vomit, gurgling or stridor
- Mobile upper jaw or broken lower jaw
- Oxygen saturation and breathing rate
- Level of consciousness and possible neck injury
Tests
- Continuous pulse oximetry and capnography
- CT of the face and head after the airway is safe
- CT of the neck if spine injury is possible
Treatment basics
- Suction blood and debris with a rigid suction catheter
- Sit the alert patient up and leaning forward if the spine allows
- Jaw thrust and oral airway; avoid nasal airways with midface fractures
- Early intubation or surgical cricothyrotomy if the airway fails
- Control bleeding with pressure and nasal packing
Red flags
- Gurgling, stridor or falling oxygen saturation
- Expanding swelling of the face or neck
- Reduced consciousness with heavy bleeding into the airway
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.