Respiratory management

• Aggressive hyperventilation is no longer recommended apart from short-term management of raised intracranial pressure. If ventilated, aim to maintain the PaC02 at 3.5-4kPa.

• Face or neck injuries may have required emergency cricothyroidotomy or tracheostomy to obtain a patent airway. If orotracheally intubated, ensure local swelling has subsided (nasendoscopy, air leak around deflated cuff) before extubation.

• Severe agitation and confusion may last for several weeks; this will often delay weaning and extubation. Judicious sedation, e.g. with chlorpromazine, may be necessary.

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