Original ContributionsEmergency airway management in penetrating neck injury☆
Section snippets
INTRODUCTION
Airway management is of paramount importance in resuscitation and thus an essential skill for the emergency medicine specialist. Penetrating neck injuries are among the most difficult airway cases to manage, but a recent literature search of airway management in the setting of penetrating neck injury revealed only 3 studies specifically addressing this topic since 19691, 2, 3 and only 1 in the emergency medicine literature.2 Penetrating neck trauma is an uncommon, challenging injury that is
MATERIALS AND METHODS
A retrospective study of ED intubations in penetrating neck trauma was conducted from January 1, 1993, to December 31, 1996, at Los Angeles County–University of Southern California Medical Center, a Level I trauma center. The setting was a large inner-city hospital with an annual ED census of 151,000 patients including more than 3,000 major trauma admissions yearly with a large proportion of penetrating injuries. A large residency training program in emergency medicine exists within our
RESULTS
During the 4-year study period, a total of 748 penetrating neck injuries were evaluated in the ED. Of these injuries, 82 (11%) required immediate emergency airway management. One out-of-hospital intubation and 23 traumatic arrests were excluded by the above criteria resulting in a study population of 58 patients.
Fifty-five patients were male and 3 were female; the average patient age was 31 years (range 15 to 77 years). Mechanisms of injury included gunshot wound in 45 (78%), stab wound in 12
DISCUSSION
Penetrating neck injury is uncommon and is coupled with its inherent management challenges. Although many articles and studies have been written on penetrating neck injury, surprisingly few address airway management; this article is the second emergency medicine study addressing this important topic.
In 1969, Ginsberg and Freinkel3 briefly described their experience with 35 cases managed by anesthesiologists in South Africa. They outlined the hazards of anesthesia in this group of patients and
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Address for reprints: Diku Mandavia, MD, FRCPC, Department of Emergency Medicine, Room 1011, General Hospital, Los Angeles County–University of Southern California Medical Center, 1200 North State Street, Los Angeles, CA 90033; 323-226-6692,fax 323-226-6454;,E-mail [email protected] .