Blind Nasotracheal Intubation for Patients With Penetrating Neck Trauma

Weitzel, Nathaen; Kendall, John L.; Pons, Peter T.

doi:10.1097/01.ta.0000071294.21893.a4

Cited by 30 publications

(15 citation statements)

References 18 publications

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“…Airway management can be extremely challenging even for the most experienced of anaesthetists or surgeons. It was impossible to secure our patients airway by conventional nasal/oral endotracheal intubation, and blind naso-tracheal intubation has lead to deaths due to inability to secure and subsequent loss of the airway (Shearer and Giesecke, 1993;Weitzel et al, 2004). Vascular control of the major vessels, removal of the foreign body and subsequent repair of structures are the accepted sequence for surgical treatment.…”

Section: Discussionmentioning

confidence: 96%

“…ATLS Ò focuses on the key areas of airway, breathing and circulation. The stable patient may have impending airway compromise due to loss of structural integrity, distortion or obstruction by surgical emphysema, fluids or a foreign body (Ginsberg and Freinkel, 1969;Herrin et al, 1979;Eggen and Jorden, 1993;Shearer and Giesecke, 1993;Mandavia et al, 2000;Weitzel et al, 2004;Powitzky et al, 2008). The neck is also at high risk from haemorrhage from the great vessels.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Elusive penetrating foreign body to the neck causing partial epiglottic airway obstruction

Rao¹,

Messahel²,

Grimes³

et al. 2011

Journal of Cranio-Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

Elusive penetrating foreign body to the neck causing partial epiglottic airway obstruction

Rao¹,

Messahel²,

Grimes³

et al. 2011

Journal of Cranio-Maxillofacial Surgery

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“…5 Overall mortality in patients with PNI ranges from 3 to 10%. 6,7 Mortality is even higher when PNI includes penetrating laryngotracheal trauma (20%) or pharyngoesophageal injuries (22%). [8][9][10] When discussing PNI, standardized nomenclature divides the neck into three anatomic zones.…”

Section: Discussionmentioning

confidence: 99%

“…Blind nasal intubation has been reported in the setting of PNI, 7,27 although it lacks support due to the possibility of causing further airway injury or bleeding. 28,29 The use of a gum elastic bougie for a patient with PNI and tracheal injury has been described in the emergency medicine literature.…”

Section: Discussionmentioning

confidence: 99%

Airway management of an open penetrating neck injury

Youssef

Raymer

2015

CJEM

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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. RÉ SUMÉBien que les plaies pé né trantes du cou (PPC) repré sentent un faible pourcentage des cas traité s dans les services d'urgence (SU), elles peuvent né anmoins entraîner une forte morbidité et une forte mortalité . Les interventions en vue du maintien de la permé abilité des voies aé riennes dans les cas de PPC varient é normé ment selon le tableau clinique et les pratiques locales, au point que les dé clarations sur la prise en charge gé né rale manquent. Si l'intubation en sé quence rapide (ISR) est sans danger chez la plupart des patients souffrant d'une PPC, le maintien de la permé abilité des voies aé riennes dans le sous-groupe de patients à risque é levé (10%) pré sentant des lé sions laryngotraché ales exige des interventions particuliè rement judicieuses. On ne sait pas si l'ISR est sû re chez ces patients, et la documentation ne fait pas é tat non plus de l'utilisation de la vidé olaryngoscopie chez les patients souffrant d'une PPC bé ante. Les principes dé jà é tablis du maintien de la permé abilité des voies aé riennes dans les cas de blessure bé ante des voies aé riennes comprennent le non-recours à la ventilation par masque et ballon à pression positive et à l'intubation à l'aveugle ainsi que la possibilité d'une ouverture chirurgicale pré coce des voies aé riennes. Comme les lé sions dans ce sous-groupe de patients à risque é levé peuvent ê tre non dé celables cliniquement à la premiè re consultation au SU, ces principes de conduite s'appliquent à tous les blessé s pré sentant une PPC jusqu'à ce que la nature du trauma soit davantage pré cisé e. Sera exposé ici le cas d'une patiente traité e au SU pour une PPC bé ante de la zone II, par suite d'une agression à l'arme blanche.

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“…Keeping in mind that glottic visualization may be facilitated as bronchoscope approaches near the epiglottis, it is important to know the nares-vocal cord length (NV length). Moreover, prediction of NV length can be useful for performing blind nasal intubation in the urgent situation (Weitzel et al, 2004) and proper positioning of ETT (Freeman et al, 1995). Blind nasal intubation is widely attempted to ensure the airway in patients with respiratory difficulty.…”

Section: Introductionmentioning

confidence: 99%