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Airway management in penetrating neck trauma at a Canadian tertiary trauma centre

Published online by Cambridge University Press:  21 May 2015

John M. Tallon ,
Jennifer M. Ahmed  and
Beth Sealy
John M. Tallon*
Affiliation:
Departments of Emergency Medicine and Surgery, Dalhousie University, Halifax, NS Nova Scotia Trauma Program, Halifax, NS
Jennifer M. Ahmed
Affiliation:
Nova Scotia Trauma Program, Halifax, NS Faculty of Medicine, Dalhousie University, Halifax, NS
Beth Sealy
Affiliation:
Nova Scotia Trauma Program, Halifax, NS
*
Nova Scotia Trauma Program, Room 1-026B, 1st Floor Centennial Building, 1278 Tower Road, Halifax NS B3H 2Y9; jtallon@dal.ca

Abstract

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Objectives:

The optimal approach to airway management in penetrating neck injuries (PNIs) remains controversial. The primary objective of this study was to review the method of endotracheal intubation in PNI at a Canadian tertiary trauma centre. Secondarily, we sought to determine the incidence of PNI in our trauma population and to describe the epidemiologic elements of this population.

Methods:

We conducted a review of patients with PNIs who were enrolled in the Nova Scotia Trauma Registry database. We included all patients 16 years of age or under who presented between April 1, 1994 and March 31, 2005 with penetrating injuries of the neck and an Injury Severity Score (ISS) of 9 or less or who underwent Trauma Team activation at our Tertiary Trauma Centre (regardless of ISS) and/or who were identified upon admission as a “major” trauma case. The variables of interest were patient age and sex, injury mechanism, injury location, place of intubation and method of intubation.

Results:

There were 19 people who met inclusion criteria and they were enrolled in our study. The injury mechanisms involved knife (n = 13) or gunshot (n = 5) wounds (one patient's injuries were categorized as “other”). Three patients (15.8%) were not intubated. The remaining 16 patients were intubated during prehospital care (n = 5), in the emergency department (n = 6) or in the operating room (n = 5). Of these, 8 patients (42.1%) underwent awake intubation and 8 (42.1%) underwent rapid sequence intubation.

Conclusion:

There is clear variability of airway management in PNI. We believe that such patients represent a heterogeneous group where the attending physician must have a conservative yet varied approach to airway management based on the individual clinical scenario.

Keywords

neck injurypenetrating woundsendotracheal intubationrapid sequence intubationtrauma center
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 2 , March 2007 , pp. 101 - 104
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Weitzel, N, Kendall, J, Pons, P. Blind nasotracheal intubation for patients with penetrating neck trauma. J Trauma 2004;56:1097–101.CrossRefGoogle ScholarPubMed
2.Mandavia, DP, Qualls, S, Rokos, I. Emergency airway management in penetrating neck injury. Ann Emerg Med 2000;35:221–5.Google Scholar
3.Shearer, VE, Giesecke, AH. Airway management for patients with penetrating neck trauma: a retrospective study. Anesth Analg 1993;77:1135–8.CrossRefGoogle ScholarPubMed
4.Eggen, JT, Jorden, RC. Airway management, penetrating neck trauma. J Emerg Med 1993;11:381–5.Google Scholar
5.Ginsberg, H, Freinkel, A. Anaesthetic problems associated with stab injuries of the neck. S Afr Med J 1969;43:647–9.Google Scholar
6.Cicala, RS, Kudsk, KA, Butts, A, et al. Initial evaluation and management of upper airway injuries in trauma patients. J Clin Anesth 1991;3:91–8.CrossRefGoogle ScholarPubMed
7.Herrin, TJ, Brzustowicz, R, Hendrickson, M. Anesthetic management of neck trauma. South Med J 1979;72:1102–6.Google Scholar
8.Desjardins, G, Varon, AJ. Airway management for penetrating neck injuries: the Miami experience. Resuscitation 2001;48:71–5.Google Scholar
9.Kendall, JL, Anglin, D, Demetriades, D. Penetrating neck trauma. Emerg Med Clin North Am 1998;16:85–105.CrossRefGoogle ScholarPubMed
10.Nason, RW, Assuras, GN, Gray, PR, et al. Penetrating neck injuries: analysis of experience from a Canadian trauma centre. Can J Surg 2001;44:122–6.Google Scholar
11.American College of Emergency Physicians. ACEP policy statements: rapid sequence intubation Available: http://www.acep.org/webportal/PracticeResources/PolicyStatements/pracmgt/RapidSequenceIntubation.htm (accessed 2000 June 27).Google Scholar
12.American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway. Anesthesiology 2003;98:1269–77.CrossRefGoogle Scholar
13.Demetriades, D, Asensio, JA, Velmahos, G, et al. Complex problems in penetrating neck trauma. Surg Clin North Am 1996;76:661–83.Google Scholar
14.Carducci, B, Lowe, RA, Dalsey, W. Penetrating neck trauma: consensus and controversies. Ann Emerg Med 1986;15:208–15.CrossRefGoogle ScholarPubMed