Edem BE, Adekwu A, Efu ME, Kuni J, Onuchukwu G, Ugwuadu J. Anaesthetic and surgical management of airway penetrating injuries in children in resource-poor setting: Case reports.
Int J Surg Case Rep 2017;
39:119-122. [PMID:
28829988 PMCID:
PMC5565629 DOI:
10.1016/j.ijscr.2017.07.047]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022] Open
Abstract
Impacted penetrating injuries in airways of children create management challenges.
Unavailability of ideal working tools worsens situations in resource-poor settings.
Practitioners should think outside box and improvise what is available to save lives.
Parents and caregivers should be responsive and keep sharp objects away from children.
Introduction
Impacted penetrating foreign body (FB) in the airway especially the postnasal space presents with management challenges. The challenges are worsened by lack of modern equipment in resource-poor settings. Two suchlike cases were managed in this report.
Presentation of cases
Case 1: A 4-year-old girl who fell on a metal rod in her mouth while playing alone. Examination revealed an agitated child in open mouth posture, with a silvery straight metallic object impacted on the hard palate and projecting from the mouth. X-ray of the post nasal space showed a radiopaque object through the hard palate impinging on the skull base.
Case 2: A 5-year-old male presented with swollen neck and difficulty in breathing following a fall on a sharp pencil while at play in school. The object which pierced through the neck was immediately removed by an attendant. Examination revealed a child in obvious respiratory distress with swollen neck, face and eyes with a slit measuring 2 cm over the crico-thyroid membrane (subcutaneous emphysema).
Discussion
With no available fibre-optic laryngoscope, classical Macintosh laryngoscopy was infeasible. With refusal of tracheostomy, the authors employed three-man intubation technique to successfully secure the airway for excision of the FB in first patient. The second was induced with IV ketamine since he could not tolerate the supine position and facemask. Due to falling oxygen saturation, an orotracheal intubation was done before a successful mid-level emergency tracheostomy was sited.
Conclusion
Penetrating airway injuries in children pose serious management challenges. Careful anticipation and quick intervention are helpful.
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