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4 results

  • Airway management of an open penetrating neck injury

  • Nayer Youssef, Karen E. Raymer
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 17 / Issue 1 / January 2015
    Published online by Cambridge University Press:
    11 February 2015, pp. 89-93
    Print publication:
    January 2015
    • Article
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  • Although penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. It is not known if RSI is safe in such patients, nor has there been reported use of videolaryngoscopy in patients with open PNI. Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such guiding principles apply to all patients with PNI until the nature of the injury is more accurately defined. In this report, we present the case of a patient who presented to the ED with a zone II open PNI, which occurred as a result of a stab wound.

  • Use of a Gum Elastic Bougie in a Penetrating Neck Trauma

  • Yann Daniel, Stanislas de Regloix, Eric Kaiser
  • Journal:
    Prehospital and Disaster Medicine / Volume 29 / Issue 2 / April 2014
    Published online by Cambridge University Press:
    28 February 2014, pp. 212-213
    Print publication:
    April 2014

  • The case of a patient with a zone II penetrating neck injury who was intubated successfully utilizing the gum elastic bougie (GEB) is reported. He presented at a forward operational base in Afghanistan with a shrapnel wound in his neck as well as a cough and hoarseness. There were two wounds on each side of his laryngeal cartilages. The patient's breathing rate gradually increased and labored inhalation developed while the aeromedical evacuation was delayed for tactical reasons. Subcutaneous emphysema and edema concealed the anatomical landmarks, making a cricothyrotomy unsafe, and no fiber optic devices were available on site. Intratracheal intubation was decided upon by the doctors involved. Because of the anticipated difficultly of intubation, the GEB was used from the outset. During direct laryngoscopy, edema, blood, and mucus concealed the anatomic reliefs of the larynx. The glottis was not visible. On the second attempt, “clicks” were clearly perceived and the tube was railroaded over the bougie. Finally, the patient was evacuated to an Afghan military hospital.

    In this report, the benefit-risk balance for the use of the GEB in penetrating neck trauma is discussed. Although the use of the GEB cannot be recommended in all cases of penetrating neck injury, it should be considered as an option. This technique is not without risk, but in very remote settings or hostile environments, especially when cricothyrotomy is not possible, it can be lifesaving.

    Daniel Y, de Regloix S, Kaiser E. Use of a Gum Elastic Bougie in a Penetrating Neck Trauma. Prehosp Disaster Med. 2014;29(2):1-2 .

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

  • John M. Tallon, Jennifer M. Ahmed, Beth Sealy
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 9 / Issue 2 / March 2007
    Published online by Cambridge University Press:
    21 May 2015, pp. 101-104
    Print publication:
    March 2007
    • Article
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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.

  • How Should an Unconscious Person with a Suspected Neck Injury be Positioned?

  • Barry D. Gunn, Norman Eizenberg, Morry Silberstein, Joan M. McMeeken, Elizabeth A. Tully, Barry C. Stillman, Douglas J. Brown, Geoffrey A. Gutteridge
  • Journal:
    Prehospital and Disaster Medicine / Volume 10 / Issue 4 / December 1995
    Published online by Cambridge University Press:
    28 June 2012, pp. 239-244
    Print publication:
    December 1995
  • Introduction:

    Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.

    Hypothesis:

    It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.

    Methods:

    Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.

    Results:

    For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).

    Conclusion:

    An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.