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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 

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