Prehospital SALAD Airway Technique in an Adolescent with Penetrating Trauma Case Report

We present a case of an adolescent patient with a penetrating gunshot wound to the mouth requiring endotracheal intubation via rapid sequence intubation in the prehospital setting. The team used video laryngoscopy (VL) to secure the airway; however, continuous bloody secretions increased the complexity of the procedure and required the application of the Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) method to facilitate intubation. By utilizing the SALAD procedure, the field of view on the VL camera remained unobscured, and the patient's airway remained clear, allowing for an uneventful intubation procedure. No episodes of hypoxia, hypotension, bradycardia, or obvious clinical signs of pulmonary aspiration occurred during the procedure. The patient was transported to a local Pediatric Level I trauma center, where he underwent emergent surgery to repair an esophageal laceration and was discharged to home 40 days later. This case highlights the importance of deliberate and proactive management of the contaminated airway in the prehospital setting. The SALAD technique replaces the Yankauer suction catheter with a larger bore suction catheter in conjunction with VL to perform gross decontamination of the mouth and airway before attempting intubation. This is followed by permanently placing the large bore suction catheter under constant suction in the posterior pharynx or esophagus to keep the VL camera unobscured by vomit or blood to facilitate intubation. After the intubation, the suction catheter may be removed unless ongoing suction is required. Keeping the VL camera unobscured during the procedure may improve first-pass intubation success rate.