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Airway management in penetrating neck trauma at a Canadian tertiary trauma centre

Published online by Cambridge University Press:  21 May 2015

John M. Tallon ,
Jennifer M. Ahmed  and
Beth Sealy
John M. Tallon*
Affiliation:
Departments of Emergency Medicine and Surgery, Dalhousie University, Halifax, NS Nova Scotia Trauma Program, Halifax, NS
Jennifer M. Ahmed
Affiliation:
Nova Scotia Trauma Program, Halifax, NS Faculty of Medicine, Dalhousie University, Halifax, NS
Beth Sealy
Affiliation:
Nova Scotia Trauma Program, Halifax, NS
*
Nova Scotia Trauma Program, Room 1-026B, 1st Floor Centennial Building, 1278 Tower Road, Halifax NS B3H 2Y9; [email protected]

Abstract

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Objectives:

The optimal approach to airway management in penetrating neck injuries (PNIs) remains controversial. The primary objective of this study was to review the method of endotracheal intubation in PNI at a Canadian tertiary trauma centre. Secondarily, we sought to determine the incidence of PNI in our trauma population and to describe the epidemiologic elements of this population.

Methods:

We conducted a review of patients with PNIs who were enrolled in the Nova Scotia Trauma Registry database. We included all patients 16 years of age or under who presented between April 1, 1994 and March 31, 2005 with penetrating injuries of the neck and an Injury Severity Score (ISS) of 9 or less or who underwent Trauma Team activation at our Tertiary Trauma Centre (regardless of ISS) and/or who were identified upon admission as a “major” trauma case. The variables of interest were patient age and sex, injury mechanism, injury location, place of intubation and method of intubation.

Results:

There were 19 people who met inclusion criteria and they were enrolled in our study. The injury mechanisms involved knife (n = 13) or gunshot (n = 5) wounds (one patient's injuries were categorized as “other”). Three patients (15.8%) were not intubated. The remaining 16 patients were intubated during prehospital care (n = 5), in the emergency department (n = 6) or in the operating room (n = 5). Of these, 8 patients (42.1%) underwent awake intubation and 8 (42.1%) underwent rapid sequence intubation.

Conclusion:

There is clear variability of airway management in PNI. We believe that such patients represent a heterogeneous group where the attending physician must have a conservative yet varied approach to airway management based on the individual clinical scenario.

Keywords

neck injurypenetrating woundsendotracheal intubationrapid sequence intubationtrauma center
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 2 , March 2007 , pp. 101 - 104
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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