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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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2
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Tanquary G, Little A, Morales-Torres JA. Air of the Dog: Impending Respiratory Failure After a Dog Bite. Cureus 2019; 11:e4304. [PMID: 31183284 PMCID: PMC6538109 DOI: 10.7759/cureus.4304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Animal and human bites represent a significant health issue worldwide. However, penetrating neck trauma secondary to animal bites is a rare presentation. We present the case of a 32-year-old female with neck pain and difficulty breathing after suffering a dog bite to the neck. Bedside ultrasound and subsequent computed tomography (CT) showed findings consistent with subcutaneous emphysema. Due to rapidly progressing neck swelling and stridor, she required advanced airway management followed by emergent exploratory surgery. We present a case report on impending respiratory failure after a dog bite and review the management of penetrating neck trauma.
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Affiliation(s)
| | - Andrew Little
- Emergency Medicine, Ohiohealth Doctors Hospital, Columbus, USA
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3
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Jain RK, Chakraborty P, Joshi P, Pradhan S, Kumari R. Penetrating Neck Injuries: from ER to OR. Indian J Otolaryngol Head Neck Surg 2018; 71:352-357. [PMID: 31741985 DOI: 10.1007/s12070-018-1307-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/14/2018] [Indexed: 10/16/2022] Open
Abstract
Neck contains several vital structures, in a small close space, in complex relationship to each other, and unprotected by any bony framework. Any injury to this crucial region, hence mostly becomes an acute emergency. Appropriately managing the same has always been a point of constant discussion amongst head and neck surgeons. The basic aim of the study was to discuss the management, comorbidities, prognosis and associated complications encountered in a series of patients with penetrating neck trauma (piercing platysma), presenting to the emergency over a period of 1 year. Combat injuries and patients declared as brought dead at the time of first examination were excluded. This was a retrospective study of patients with cut throat injury, managed at a tertiary center of northern India from June 2014 to September 2015. Following management in the ER as per ATLS guidelines, all patients were then operated for specific injuries. Graph pad software was used for statistical analysis. Of the 15 patients studied in total, 11 (73.3%) were males. The mean patient age was 33.67 years. Mean duration of presentation was 20.85 h. 60% patients had homicidal injuries. Tracheostomy and Ryle's tube insertion was done in 8 (53.3%) patients. Exploration and surgical repair was done in all patients without any mortality. 4 patients developed post-operative complications. Mean duration of hospital stay was 9.2 days. Immediate resuscitation followed by exploration and primary repair is a must in all patients of penetrating neck injury.
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Affiliation(s)
- Rajiv Kumar Jain
- Department of E.N.T, IMS BHU, Flat no 114, Ambrosia Apartments, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Priyanko Chakraborty
- Department of E.N.T, IMS BHU, Room No-215, Susruta Hostel, Trauma center campus, Varanasi, Uttar Pradesh 221005 India
| | - Purnima Joshi
- Department of E.N.T, IMS BHU, Room No.-5, Ladies Doctors Hostel, Varanasi, Uttar Pradesh 221005 India
| | - Sidharth Pradhan
- Department of E.N.T, IMS BHU, Room No-130, Susruta Hostel, Trauma Center Campus, Varanasi, Uttar Pradesh 221005 India
| | - Rakhi Kumari
- Department of E.N.T, IMS BHU, Santpath Vachaspatinagar, Kumhrar, Patna, Bihar 800006 India
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4
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Johnson AM, Hill JL, Zagorski DJ, McClain JM, Maronian NC. Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report. A A Pract 2018; 10:242-245. [PMID: 29708920 DOI: 10.1213/xaa.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airway by the method they are most comfortable, have high suspicion of airway injury, and prepare to manage airway disruption.
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Affiliation(s)
| | - James L Hill
- From the Department of Anesthesia and Perioperative Medicine
| | - Dave J Zagorski
- From the Department of Anesthesia and Perioperative Medicine
| | | | - Nicole C Maronian
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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5
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Abstract
Penetrating injury to the neck has inspired considerable controversy with regard to its management, owing to the large number of important, susceptible structures contained in this area. Mandatory exploration of all wounds has generally given way to selective operative management. Clinical assessment has, once again, become the prime diagnostic tool. This review describes the evolution of management and the value of various diagnostic modalities. It concludes with a summary of appropriate operative techniques.
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Affiliation(s)
- Campbell MacFarlane
- Emergency Medical Services Training, Gauteng Provincial Government Department of Health and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Ann Benn
- Chris Hani Baragwanath Hospital, Johannesburg and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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6
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Abstract
The ability of the emergency physician to recognize and manage a patient with a compromised airway is probably the most important aspect of an individual’s care in the emergency department. Endotracheal intubation in a critically ill patient is a potentially hazardous procedure because of the technical difficulties that can be encountered during emergency airway management and the profound pathophy siological changes that the institution of mechanical ventilation can cause. This review article sets out to illustrate when invasive airway management should be considered and the potential consequences of attempts to perform endotracheal intubation and mechanical ventilation.
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Affiliation(s)
| | - Mav Manji
- University Hospital Birmingham NHS Trust, Birmingham, UK,
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7
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Winders WT, Powell E, Tilney PVR. A 58-Year-Old Man With Self-Inflicted Facial Trauma. Air Med J 2016; 35:103-6. [PMID: 27255867 DOI: 10.1016/j.amj.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
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Tallon JM, Ahmed JM, Sealy B. Airway management in penetrating neck trauma at a Canadian tertiary trauma centre. CAN J EMERG MED 2015; 9:101-4. [PMID: 17391580 DOI: 10.1017/s148180350001486x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT
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.
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Affiliation(s)
- John M Tallon
- Department of Emergency Medicine, Dalhousie University, Halifax, NS.
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Cooper JA, Hunter CJ. Jael's Syndrome: Facial Impalement. West J Emerg Med 2013; 14:158-60. [PMID: 23599858 PMCID: PMC3628470 DOI: 10.5811/westjem.2012.7.11984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/17/2012] [Accepted: 07/09/2012] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jennifer A Cooper
- Brooke Army Medical Center, Department of Emergency Medicine, San Antonio, Texas
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10
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Mercer SJ, Lewis S, Wilson S, Groom P, Mahoney P. Creating Airway Management Guidelines for Casualties with Penetrating Airway Injuries. J ROY ARMY MED CORPS 2010; 156:355-60. [DOI: 10.1136/jramc-156-04s-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Casey SJ, De Alwis WD. Review article: Emergency department assessment and management of stab wounds to the neck. Emerg Med Australas 2010; 22:201-10. [DOI: 10.1111/j.1742-6723.2010.01285.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Rao J, Messahel A, Grimes K, Sanders K. Elusive penetrating foreign body to the neck causing partial epiglottic airway obstruction. J Craniomaxillofac Surg 2010; 39:37-9. [PMID: 20456968 DOI: 10.1016/j.jcms.2010.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022] Open
Abstract
We present a case of a penetrating foreign body to the neck, which was difficult to detect, causing partial epiglottic and laryngeal outlet airway obstruction, and subsequent intubation challenges. A systematic approach with rapid access to contrast enhanced CT scanning allowed successful airway and haemorrhage control, removal of a wooden stake from the patient's neck, initially undetected at primary and secondary assessments.
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Affiliation(s)
- Jeethendra Rao
- Maxillofacial Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
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13
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Gulsen S, Sönmez E, Aydemir F, Caner H, Altinors N. Settled nail injury in the corpus of the seventh cervical vertebra. Neurol Med Chir (Tokyo) 2007; 47:415-8. [PMID: 17895615 DOI: 10.2176/nmc.47.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 26-year-old construction worker presented with a nail settled in the C-7 corpus. He had no neurological or physical abnormalities. Preoperative evaluation of the vascular, neural, and aerodigestive structures with cervical radiography, computed tomography (CT), CT angiography, and contrast esophagography found no damage. The nail was completely exposed surgically and removed. The patient recovered with no deficits. Penetrating neck injury may be associated with significant morbidity and mortality due to vascular, neural, and aerodigestive tract injury. Patients in stable clinical condition should be evaluated by CT angiography, esophagography, and chest and cervical radiography.
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Affiliation(s)
- Salih Gulsen
- Department of Neurosurgery, Faculty of Medicine, Baskent University Medical Faculty, Ankara, Turkey.
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14
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Weitzel N, Kendall J, Pons P. Blind Nasotracheal Intubation for Patients With Penetrating Neck Trauma. ACTA ACUST UNITED AC 2004; 56:1097-101. [PMID: 15179252 DOI: 10.1097/01.ta.0000071294.21893.a4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early airway management is advocated for patients with penetrating neck trauma who have any signs of airway compromise. This study examined the clinical course of patients with penetrating neck trauma who received prehospital blind nasotracheal intubation, including successful intubation rates, and outcomes. METHODS A retrospective review of patients admitted to the emergency department for penetrating neck trauma was conducted from January 1, 1993 to July 1, 2001 at the Denver Health Medical Center. Patients were identified from the trauma registry, and data were collected using standardized inclusion and exclusion criteria. RESULTS The study identified 240 patients with penetrating neck trauma. Overall mortality was 8.3%. Among the 240 patients, 89 (37%) required airway management, and 40 (17%) underwent prehospital management with blind nasotracheal intubation. The success rate for prehospital intubation using the blind nasotracheal method was 90%. The mean number of attempts was 1.16 (range, 1-4), and the mortality in this group was 5%. CONCLUSION The patients managed with blind nasotracheal intubation did not experience complications related to the choice of airway management. Despite prior warnings in the literature, the results of this study suggest that blind nasotracheal intubation may well be a valuable tool for the management of patients with penetrating neck trauma.
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Affiliation(s)
- Nathaen Weitzel
- University of Colorado Health Sciences Center, Denver, Colorado, USA
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Dunham CM, Barraco RD, Clark DE, Daley BJ, Davis FE, Gibbs MA, Knuth T, Letarte PB, Luchette FA, Omert L, Weireter LJ, Wiles CE. Guidelines for emergency tracheal intubation immediately after traumatic injury. THE JOURNAL OF TRAUMA 2003; 55:162-79. [PMID: 12855901 DOI: 10.1097/01.ta.0000083335.93868.2c] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bowley DM, Robertson SJ, Boffard KD, Bhagwanjee S. Resuscitation and anaesthesia for penetrating trauma. Curr Opin Anaesthesiol 2003; 16:165-71. [PMID: 17021456 DOI: 10.1097/00001503-200304000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW The worldwide burden of trauma is increasing, but is unequal between nations. Trauma targets the young and productive in society and imposes a major burden on the health infrastructure. This review provides a distillation of practice in a busy urban trauma centre dealing with large volumes of penetrating trauma. RECENT FINDINGS The anaesthetist holds a pivotal role in the management of penetrating injury; the requirements of prompt airway control, early delivery to theatre and control of a physiologically brittle patient can be challenging. Recognition that attempts at definitive surgery in exsanguinating patients may do more harm than good has made surgery a tool of resuscitation rather than an end in itself. SUMMARY Depending on where they practice, clinicians are more or less likely to encounter patients with gunshot wounds. However, adherence to basic principles and attention to the details of temperature control, invasive haemodynamic monitoring, blood product therapy and effective communication should translate to improved outcomes for patients after penetrating trauma.
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Affiliation(s)
- Douglas M Bowley
- University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
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17
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Abstract
The patient with head and neck disease has several peculiarities that need to be recognized for the treating team to offer optimal care. These arise from the primary disorders (eg, head and neck cancer or injuries) and the morbidity they might cause, the associated comorbidities, and the possible complications of treatment. A team approach involving the surgeon, the intensivist, and other caretaking personnel is essential to achieve high-quality care and ensure the best results possible.
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Affiliation(s)
- Stavros Garantziotis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, 275 Medical Sciences Research Building, Box 2629, Durham, NC 27710, USA.
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18
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Shetty S, Gupta S, Hasan S, Cherian M. Facio-cervical transfixion by a metallic rod: a case report. Am J Otolaryngol 2001; 22:160-3. [PMID: 11283836 DOI: 10.1053/ajot.2001.22589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Foreign bodies penetrating into the neck may cause extensive neurovascular and aerodigestive tract injuries. Facio-cervical transfixion by a metallic rod without such injuries is very rare. The patient presented in this article reported to our center 5 hours after the road traffic accident with impacted hollow metallic rod traversing through the tongue, pharynx, and neck after causing fracture to maxilla. Exploration under general anesthesia after tracheostomy resulted in an uneventful extraction of the metallic rod. Postoperatively, the patient recovered completely and had no neurologic deficits. [Editorial comment: This case report demonstrates an approach to an extremely difficult and potentially dangerous clinical problem. The authors decision to forego angiography is based on physical examination with evidence of palpable flow in the superficial temporal artery.]
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Affiliation(s)
- S Shetty
- Department of Otorhinolaryngology and Head & Neck Surgery, St John's Medical College Hospital, Bangalore-560 034, India
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19
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Abstract
STUDY OBJECTIVES Airway management in the context of penetrating neck injury is a challenging scenario. Management decisionmaking has not been well studied and the initial airway approach remains controversial. We examined various initial emergency airway techniques and their success in the setting of penetrating neck trauma. METHODS A retrospective study was conducted of emergency department intubations in penetrating neck injury from January 1, 1993, to December 31, 1996, at a Level I trauma center. Cases of out-of-hospital traumatic arrest or out-of-hospital intubation were excluded. Successful airway management was defined as endotracheal tube placement confirmed by clinical evaluation, pulse oximetry, chest radiography, and end-tidal CO(2) detection. RESULTS During the study period, 748 consecutive patients with penetrating neck injury were evaluated in the ED. Of these, 82 (11%) were deemed to require immediate airway management. Twenty-four of the 82 were excluded because of out-of-hospital traumatic arrest or out-of-hospital intubation, resulting in a study population of 58 patients. Of these 58 patients, 39 had initial rapid sequence intubation using succinylcholine with a 100% success rate. Five comatose patients had successful orotracheal intubation without paralysis, and 2 patients underwent successful emergency tracheostomy. The remaining 12 patients had initial fiberoptic intubation by otolaryngology clinicians, which was unsuccessful in 3 patients. All 3 of these patients were subsequently successfully orotracheally intubated using the rapid sequence intubation technique. Therefore, oral endotracheal intubation was the definitive method of airway management in 47 (81%) of the 58 patients and was successful in all cases. CONCLUSION Rapid sequence intubation was the most commonly performed initial technique by emergency physicians and was safe and effective in all cases attempted. Furthermore, rapid sequence intubation methodology resulted in successful intubation of the fiberoptic intubation failures. Physicians with airway expertise should consider using rapid sequence intubation as an initial airway technique in managing patients with penetrating neck injury who require airway control.
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Affiliation(s)
- D P Mandavia
- Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA.
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20
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Apfelbaum JD, Cantrill SV, Waldman N. Unstable cervical spine without spinal cord injury in penetrating neck trauma. Am J Emerg Med 2000; 18:55-7. [PMID: 10674533 DOI: 10.1016/s0735-6757(00)90049-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cervical spine instability in the neurologically intact patient following penetrating neck trauma has been considered rare or non-existent. We present a case of a woman with an unstable C5 fracture without spinal cord injury after a gunshot wound to the neck. Considerations regarding the risk of cervical spine instability are discussed, as well as suggestions for a prudent approach to such patients.
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Affiliation(s)
- J D Apfelbaum
- Denver Health Medical Center, Department of Emergency Medicine, CO, USA
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21
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Abstract
Penetrating neck trauma can pose significant diagnostic and therapeutic challenges for emergency physicians. Factors contributing to these problems are complex anatomy, proximity of vital structures, and potential for rapid deterioration of airway, vascular, or neurologic injuries. Other contributing factors are the lack of consensus in the literature regarding appropriate evaluation and management of penetrating neck injuries, and insufficient resources or experienced personnel at some institutions. This review focuses on the key components of the history and physical examinations that allow for an assessment of the severity and type of structures involved. In addition, current methods of airway management, as well as ways to manage penetrating neck trauma efficiently and cost effectively, are discussed.
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Affiliation(s)
- J L Kendall
- Department of Emergency Medicine, Denver Health Medical Center, Colorado, USA
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