Respiratory management

• Consider the possibility of a fractured, unstable neck, especially in unconscious patients. This should be excluded by appropriate radiology and an expert opinion. Until then the neck should be immobilised.

• If ventilated, ensure haemodynamic stability, removal of any metabolic acidosis, adequate rewarming and satisfactory gas exchange before attempting to wean. If the patient remains unstable, it is advisable to delay extubation in case urgent surgery is required.

• If spontaneously breathing, give supplemental oxygen to provide adequate arterial oxygenation, encourage deep breathing to prevent atelectasis and secondary infection, and ensure sufficient analgesia, albeit not too much to suppress ventilatory drive.

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