Difficult Endotracheal Intubation as a Result of Penetrating Cranio-Facial Injury by an Arrow

Joly, Luc‐Marie; Oswald, A.; M, Disdet; Raggueneau, J L

doi:10.1097/00000539-200201000-00045

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…A rapidly expanding hematoma causing airway obstruction must also be considered [6]. Even though awake fiberoptic intubation is the standard for traumatic airway injury and has been successfully performed in other instances of penetrating facial injury [5], it was unsuccessful in this case because the patient had active hemorrhage from an arterial transection that significantly obscured visualization of the airway anatomy. Furthermore, the patient was intoxicated and uncooperative with the fiberoptic intubation and every attempt with the bronchoscope only worsened his agitation.…”

Section: Discussionmentioning

confidence: 97%

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Airway Management of Penetrating Facial Trauma from an Impaled Screwdriver: A Case Report

Rajagopalan

2020

GJAPM

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Airway management of a patient with penetrating facial trauma is often anticipated to be difficult. However, due to the variation in presentation of penetrating facial trauma, there are no consensus guidelines established for securing the airway. We present a case of penetrating facial trauma with an impaled screwdriver, describe the anatomical significance of the embedded foreign object, and suggest an approach to airway management. Ultimately, a skilled provider must use his or her clinical judgement and have a clear understanding of anatomy to best approach these unique scenarios.He was then premedicated with midazolam and fentanyl prior to any intubation attempts. The oropharynx was gently suctioned, and 4% lidocaine hurricane spray was administered. Because of the anticipated difficult airway, an awake fiberoptic intubation was Volume 3 -Issue 5 Copyrights @ Suman Rajagopalan, et al. Glob J Anes & Pain Med

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Section: Discussionmentioning

confidence: 97%

“…However, there is no current consensus amongst the anesthesia community on airway management of penetrating maxillofacial injuries and much variability exists [2][3][4][5]. Here, we present a case of an impaled foreign body to the face and our approach to airway management of this patient.…”

Section: Introductionmentioning

confidence: 94%

Airway Management of Penetrating Facial Trauma from an Impaled Screwdriver: A Case Report

Rajagopalan

2020

GJAPM

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“…As most victims show some survival time after the injury, it is possible that the arrow may be removed by the victim themselves8 . Despite their low kinetic energy (compared with projectiles from guns), crossbow arrows have a high penetration force, and may be sufficient to enable penetration of the skull at short range, as in the current case20 . The cutting edge of the arrow is extremely sharp, facilitating penetration of tissue4 .There are no significant pathological differences among suicidal, homicidal, and accidental fatal crossbow injuries in the literature.…”

mentioning

confidence: 86%

Autopsy Case of a Penetrating Wound to the Left Cerebral Hemisphere Caused by an Accidental Shooting With a Crossbow

Kondo¹,

Takahashi²,

Kuse³

et al. 2018

Am J Forensic Med Pathol

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A crossbow is a bow that shoots an arrow when a gun-like trigger is pulled. Deaths caused by accidental crossbow shootings are extremely rare. Here we describe an autopsy case of a penetrating wound to the left cerebral hemisphere caused by an accidental shooting with a crossbow. A man in his early 60s who lived with his wife and had used crossbows for 20 years as his hobby was found one early morning in the shed of his house, collapsed and bleeding from the head and neck. He was taken to a hospital and died after approximately 3 days of conservative treatment. At autopsy, a penetrating wound between the upper part of the left anterior neck and the left frontoparietal region was evident. Traumatic intracerebral hematoma was observed in the left frontal lobe, and severe traumatic subarachnoid hemorrhage was present throughout the brain. Cerebral contusion and hematoma without any organization were noted around the penetration. The cause of death was determined to be cerebral contusion and intracerebral hematoma due to the penetrating wound by the crossbow arrow. He was probably trying to load an arrow into the crossbow by placing it on the floor, pointing upward, and made a mistake in its operation that resulted in the shooting of the arrow. This case is unique because it was a rare accidental death caused by a crossbow arrow, and a detailed histopathological examination was performed.

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“…Examples included transfixion through the floor of the mouth with a bamboo cane [17], penetration of the mouth floor with a nail [18], a spear gun shaft penetrating the floor of the mouth [19] and a crossbow arrow entering under the chin and passing through the tongue, nasal cavity and between the frontal lobes [20]. Methods of management included awake fibreoptic intubation (AFOI) [17][18][19][20] rapid sequence induction of anaesthesia (RSI) [22,23] and surgical tracheostomy following failure of AFOI [19].…”

Section: Penetrating Injury Though the Mouthmentioning

confidence: 99%

Creating Airway Management Guidelines for Casualties with Penetrating Airway Injuries

et al. 2010

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Anaesthetists in the Defence Medical Services (DMS) are currently dealing with casualties who have an increased prevalence of injuries due to blast, fragmentation and gunshot wounds. Despite guidelines already existing for unanticipated difficult tracheal intubation these have been designed for a civilian population and might not be relevant for the anticipated difficult airway experienced in the deployed field hospital. In order to establish an overview of current practice, three methods of investigation were undertaken; a literature review, a survey of DMS Anaesthetists and a search of the UK Joint Theatre Trauma Database. Results are discussed in terms of anatomical site, bleeding in the airway, facial distortion, patient positioning and an anaesthetic approach. There are certain key principles that should be considered in all cases and these are considered. Potential pitfalls are discussed and our initial proposed guidelines for use in the deployed field hospital are presented.

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Difficult Endotracheal Intubation as a Result of Penetrating Cranio-Facial Injury by an Arrow

Cited by 6 publications

References 5 publications

Airway Management of Penetrating Facial Trauma from an Impaled Screwdriver: A Case Report

Airway Management of Penetrating Facial Trauma from an Impaled Screwdriver: A Case Report

Autopsy Case of a Penetrating Wound to the Left Cerebral Hemisphere Caused by an Accidental Shooting With a Crossbow

Creating Airway Management Guidelines for Casualties with Penetrating Airway Injuries

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