Graphic medical images herein!
Here is the case report
Near-Complete Supraglottic transection of the Larynx after a motorbike accident
Neck and laryngeal trauma can present a tricky challenge for airway management. Paradoxically it can also present a straightforward solution!
This open access case report from Sydney demonstrates these aspects – looks horrible but in fact handled in straightforward manner = RSI and insertion of ETT via traumatic neck wound through lacerated thyro-hyoid ligament space.
Literally appears as a digital intubation!
Prof Simon Carley of STEMLYNS tweeted a very similar case report today which I had to mention to contrast to this Sydney report.
Here is the Manchester case report
Management of an open airway :unusual presentation
I give credit to the authors as they report on their experience and initial failed primary airway plan of RSI and oral ETI attempt. IN fact the situation deteriorated and needed rescue via insertion of ETT through the neck wound, like the Sydney case.
They describe a range of options in airway management in such cases of laryngeal trauma and open injuries. Clearly in each case report, the patients’ initial presentation was sufficiently stable as to allow transfer to operating room so therefore I found it remarkable that RSI was chosen in each case here as primary anaesthetic technique. In the Sydney case it was successful as direct tracheal intubation was planned and achieved through the laryngeal wound.
I would have thought if patient relatively stable then analgesia and topical anaesthesia of the trachea might have been a reasonable alternative technique, with maintenance of spontaneous respirations.
Take home message = when trauma patient creates their own surgical airway, consider using it!