Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T11:19:18.510Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of a Gum Elastic Bougie in a Penetrating Neck Trauma

Published online by Cambridge University Press:  28 February 2014

Yann Daniel ,
Stanislas de Regloix  and
Eric Kaiser
Yann Daniel*
Affiliation:
Service Médical du 17ème Régiment du Génie Parachutiste, Montauban, France
Stanislas de Regloix
Affiliation:
Service Médical du 1er Régiment de Hussards Parachutistes, Tarbes, France
Eric Kaiser
Affiliation:
Service d'Anesthésie de l'Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
*
Correspondence: Yann Daniel, MD Service Médical du 17ème RGP CMA Montauban BP 762 82013 Montauban CEDEX, France E-mail yadaniel@hotmail.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Daniel Y, de Regloix S, Kaiser E. Use of a Gum Elastic Bougie in a Penetrating Neck Trauma. Prehosp Disaster Med. 2014;29(2):1-2 .

Keywords

airway managementmilitary medicineneck injurywilderness medicine
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 2 , April 2014 , pp. 212 - 213
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Breeze, J, Bryant, D. Current concepts in the epidemiology and management of battlefield head, face and neck trauma. J R Army Med Corps. 2009;155(4):274-278.Google Scholar
2. Brennan, J, Lopez, M, Gibbons, MD, et al. Penetrating neck trauma in Operation Iraqi Freedom. Otolaryngol Head Neck Surg. 2011;144(2):180-185.Google Scholar
3. Breeze, J, Allanson-Bailey, LS, Hunt, NC, et al. Mortality and morbidity from combat neck injury. J Trauma Acute Care Surg. 2012;72(4):969-974.Google Scholar
4. Burgess, CA, Dale, OT, Almeyda, R, Corbridge, RJ. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol. 2012;37(1):44-52.Google Scholar
5. Donat, A, Petitjeans, F, Precloux, P, et al. Cricothyrotomy for airways management: current data and interest for combat casualty care. Ann Fr Anesth Reanim. 2012;31(2):141-151.Google Scholar
6. Boon, JM, Abrahams, PH, Meiring, JH, Welch, T. Cricothyroidotomy: a clinical anatomy review. Clin Anat. 2004;17(6):478-486.Google Scholar
7. Langeron, O, Bourgain, JL, Laccoureye, O, et al. Difficult airway algorithms and management: question 5. Société Française d'Anesthésie et de Réanimation. Ann Fr Anesth Reanim. 2008;27(1):41-45.Google Scholar
8. Shah, KH, Kwong, BM, Hazan, A, Newman, DH, Wiener, D. Success of the gum elastic bougie as a rescue airway in the emergency department. J Emerg Med. 2011;40(1):1-6.Google Scholar
9. Jabre, P, Combes, X, Leroux, B, et al. Use of gum elastic bougie for prehospital difficult intubation. Am J Emerg Med. 2005;23(4):552-555.Google Scholar
10. Combes, X, Le Roux, B, Suen, P, et al. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology. 2004;100(5):1146-1150.Google Scholar
11. Adnet, F. Intubation difficile en urgence. In: Arnette, eds. Contrôle des voies aériennes en urgence. Rueil-Malmaison, France: Wolters Kluwer; 2006:131-133.Google Scholar
12. Mandavia, DP, Qualls, S, Rokos, I. Emergency airway management in penetrating neck injury. Ann Emerg Med. 2000;35(3):221-225.Google Scholar
13. Tallon, JM, Ahmed, JM, Sealy, B. Airway management in penetrating neck trauma at a Canadian tertiary trauma centre. CJEM. 2007;9(2):101-104.Google Scholar
14. Jagannathan, S, Sighn, N, Tong, JL. Creating airway management guidelines for casualties with penetrating airway injuries. J R Army Med Corps. 2011;157(3):256-257; ; author reply 257. .Google Scholar
15. 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(3):267-270.Google Scholar