Use of a gum elastic bougie (GEB) in a zone II penetrating neck trauma: a case report

Steinfeldt, Jennifer; Bey, Tareg; Rich, James M.

doi:10.1016/s0736-4679(02)00749-7

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…This is why there are almost no cases reported where a GEB is used in a penetrating neck trauma. Steinfeldt et al have reported one case, but they have inserted the bougie directly through the anterior open neck 15 . This case highlights the usefulness of the GEB for airway management of penetrating neck injuries in an austere environment.…”

Section: Discussionmentioning

confidence: 87%

Use of a Gum Elastic Bougie in a Penetrating Neck Trauma

Daniel¹,

Regloix²,

Kaiser

2014

Prehosp. Disaster med.

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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.

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Section: Discussionmentioning

confidence: 87%

Use of a Gum Elastic Bougie in a Penetrating Neck Trauma

Daniel¹,

Regloix²,

Kaiser

2014

Prehosp. Disaster med.

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“…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. 11 Although this report described its successful use, the authors cautioned that as a blind technique, it carries the risk of tracheal transection, and they recommend the use of fibre-optic bronchoscopy, where possible, to visualize (and avoid extending) intraluminal injuries.…”

Section: Discussionmentioning

confidence: 93%

“…Zone II generally confers a lower mortality due to the ready access for surgical exploration, as well as the ability to control hemorrhage with direct pressure. 11 Although historically surgical exploration was recommended for all zone II PNIs, it has been shown more recently that conservative evaluation with panendoscopy and arteriography is appropriate in selected cases. 12 In contrast, the airway management of PNI is guided by clinical presentation rather than by zone.…”

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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“…An ETTI’s location in the trachea is classically confirmed after blind placement by tactile stimuli, including “clicks” of the ETTI deflecting off the tracheal cartilage rings, and “hold up”, when forward advancement of the ETTI is halted at the carina 7. Were tactile confirmation and reattempts allowed, a higher ultimate success rate potentially could have been achieved.…”

Section: Discussionmentioning

confidence: 99%