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Airway management of an open penetrating neck injury

Published online by Cambridge University Press:  11 February 2015

Nayer Youssef  and
Karen E. Raymer
Nayer Youssef
Affiliation:
Department of Anesthesiology, McMaster University, Hamilton, ON
Karen E. Raymer*
Affiliation:
Department of Anesthesiology, McMaster University, Hamilton, ON
*
Correspondence to: Dr. Karen E. Raymer, Department of Anesthesiology, McMaster University, 1200 Main Street West, HSC-2U1, Hamilton, ON L8N 3Z5; karenraymer@cogeco.ca.

Abstract

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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.

Keywords

airway managementcut throatneck injurypenetrating neck injurytrauma
Type
Case Report
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 89 - 93
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

References

1.Demetriades, D, Skalkides, J, Sofianos, C, et al. Carotid artery injuries: experience with 124 cases. J Trauma 1989;29:91–94, doi:10.1097/00005373-198901000-00019.CrossRefGoogle ScholarPubMed
2.Pakarinen, TK, Leppaniemi, A, Sihvo, E, et al. Management of cervical stab wounds in low volume trauma centres: systematic physical examination and low threshold for adjunctive studies, or surgical exploration. Injury 2006;37:440–447, doi:10.1016/j.injury.2006.01.044.CrossRefGoogle ScholarPubMed
3.Tallon, JM, Ahmed, JM, Sealy, B. Airway management in penetrating neck trauma at a Canadian tertiary trauma centre. CJEM 2007;9:101–104.CrossRefGoogle Scholar
4.Demetriades, D, Theodorou, D, Cornwell, E 3rd, et al. Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow Doppler imaging. Arch Surg 1995;130:971–975, doi:10.1001/archsurg.1995.01430090057019.CrossRefGoogle ScholarPubMed
5.McConnell, DB, Trunkey, DD. Management of penetrating trauma to the neck. Adv Surg 1994;27:97–127.Google ScholarPubMed
6.Bell, RB, Osborn, T, Dierks, EJ, et al. Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg 2007;65:691–705, doi:10. 1016/j.joms.2006.04.044.CrossRefGoogle ScholarPubMed
7.Weitzel, N, Kendall, J, Pons, P. Blind nasotracheal intubation for patients with penetrating neck trauma. J Trauma 2004;56:1097–1101, doi:10.1097/01.TA.0000071294.21893.A4.CrossRefGoogle ScholarPubMed
8.Asensio, JA, Berne, J, Demetriades, D, et al. Penetrating esophageal injuries: time interval of safety for preoperative evaluation—how long is safe? J Trauma 1997;43:319–324, doi:10.1097/00005373-199708000-00018.CrossRefGoogle ScholarPubMed
9.Bryant, AS, Cerfolio, RJ. Esophageal trauma. Thorac Surg Clin 2007;17:63–72, doi:10.1016/j.thorsurg.2007.02.003.CrossRefGoogle ScholarPubMed
10.Demetriades, D, Asensio, JA, Velmahos, G, et al. Complex problems in penetrating neck trauma. Surg Clin North Am 1996;76:661–683, doi:10.1016/S0039-6109(05)70475-8.CrossRefGoogle ScholarPubMed
11.Steinfeldt, J, Bey, TA, Rich, JM. Use of a gum elastic bougie (GEB) in a zone II penetrating neck trauma: a case report. J Emerg Med 2003;24:267–270, doi:10.1016/S0736-4679(02)00749-7.CrossRefGoogle Scholar
12.Tisherman, SA, Bokhari, F, Collier, B, et al. Clinical practice guideline: penetrating zone II neck trauma. J Trauma 2008;64:1392doi:10.1097/TA.0b013e3181692116.Google ScholarPubMed
13.Demetriades, D, Theodorou, D, Cornwell, EE, et al. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg 1997;21:41–48, doi:10.1007/s002689900191.CrossRefGoogle ScholarPubMed
14.Bent, JP 3rd, Silver, JR, Porubsky, ES. Acute laryngeal trauma: a reviewof 77 patients. Otolaryngol Head Neck Surg 1993;109:441–449.CrossRefGoogle Scholar
15.Eggen, JT, Jorden, RC. Airway management, penetrating neck trauma. J Emerg Med 1993;11:381–385, doi:10.1016/0736-467993):90238–3.CrossRefGoogle ScholarPubMed
16.Minard, G, Kudsk, KA, Croce, MA, et al. Laryngotracheal trauma. Am Surg 1992;58:181–187.Google ScholarPubMed
17.Stockinger, ZT, McSwain, NE Jr.. Prehospital endotracheal intubation for trauma does not improve survival over bagvalve- mask ventilation. J Trauma 2004;56:531–536, doi:10.1097/01.TA.0000111755.94642.29.CrossRefGoogle ScholarPubMed
18.Brywczynski, JJ, Barrett, TW, Lyon, JA, et al. Management of penetrating neck injury in the emergency department: astructured literature review. Emerg Med J 2008;25:711–715, doi:10.1136/emj.2008.058792.CrossRefGoogle Scholar
19.Inaba, K, Barmparas, G, Ibrahim, D, et al. Clinical examination is highly sensitive for detecting clinically significant spinal injuries after gunshot wounds. J Trauma 2011;71:523–527.Google ScholarPubMed
20.Lustenberger, T, Talving, P, Lam, L, et al. Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients. J Trauma 2011;70:870–872, doi:10.1097/TA.0b013e3181e7576e.Google Scholar
21.Rhee, P, Kuncir, EJ, Johnson, L, et al. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. J Trauma 2006;61:1166–1170, doi:10.1097/01.ta.0000188163.52226.97.CrossRefGoogle ScholarPubMed
22.Stuke, LE, Pons, PT, Guy, JS, et al. Prehospital spine immobilization for penetrating trauma—review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma 2011;71:763–769; discussion 769-70 doi:10.1097/TA.0b013e3182255cb9.Google ScholarPubMed
23.Vanderlan, WB, Tew, BE, Seguin, CY, et al. Neurologic sequelae of penetrating cervical trauma. Spine (Phila Pa 1976 2009;34:2646–2653, doi:10.1097/BRS.0b013e3181bd9df1.CrossRefGoogle Scholar
24.Mandavia, DP, Qualls, S, Rokos, I. Emergency airway management in penetrating neck injury. Ann Emerg Med 2000;35:221–225, doi:10.1016/S0196-0644(00)70071-0.CrossRefGoogle ScholarPubMed
25.Walls, RM. Airway management. Emerg Med Clin North Am 1993;11:53–60.CrossRefGoogle ScholarPubMed
26.Huh, H, Han, JH, Chung, JY, et al. Anesthetic management of penetrating neck injury patient with embedded knife—a case report. Korean J Anesthesiol 2012;62:172–174, doi:10.4097/kjae.2012.62.2.172.CrossRefGoogle Scholar
27.Shearer, VE, Giesecke, AH.. Airway management for patients with penetrating neck trauma: a retrospective study. Anesth Analg 1993;77:1135–1138, doi:10.1213/00000539-199312000-00009.CrossRefGoogle ScholarPubMed
28.Ligier, B, Buchman, TG, Breslow, MJ, et al.. The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims. Surg Gynecol Obstet 1991;173:477–481.Google ScholarPubMed
29.Shrager, JB.. Tracheal trauma. Chest Surg Clin N Am 2003;13:291–304, doi:10.1016/S1052-3359(03)00004-8.CrossRefGoogle ScholarPubMed
30.Sakles, JC, Mosier, J, Chiu, S, et al.. A comparison of the CMAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med 2012;60:739–748, doi:10.1016/j.annemergmed.2012.03.031.CrossRefGoogle Scholar
31.Ezeanolue, BC.. Management of the upper airway in severe cut-throat injuries. Afr J Med Med Sci 2001;30:233–235.Google ScholarPubMed
32.Rathlev, NK, Medzon, R, Bracken, ME. Evaluation and management of neck trauma. Emerg Med Clin North Am 2007;25:679–694; viii, doi:10.1016/j.emc.2007.06.006.CrossRefGoogle ScholarPubMed
33.Mussi, A, Ambrogi, MC, Ribechini, A, et al. Acute major airway injuries: clinical features and management. Eur J Cardiothorac Surg 2001;20:46–51; discussion 51-2 doi:10. 1016/S1010-794001): 00702–3.CrossRefGoogle ScholarPubMed