From Prone to Prepared: Airway Management in a Patient With Penetrating Thoracic Trauma.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Cureus Pub Date : 2024-12-22 eCollection Date: 2024-12-01 DOI:10.7759/cureus.76193
André Santos, Beatriz Leal, Francisco Valente
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Abstract

Perioperative and critical care management following penetrating thoracic trauma represents a complex challenge. Those who survive the early trauma approach and reach the hospital alive often remain in critical condition, with cardiocirculatory complications and major pulmonary injuries. Additional difficulty arises from the presence of a weapon in situ, particularly in a dorsal location, which limits patient positioning, and the safe manipulation of both the weapon and the patient. We present the case of a 47-year-old man, who suffered a stabbing assault, resulting in a deep dorsal thoracic wound with the knife still in situ. The patient was initially treated by the pre-hospital team, where the weapon was stabilized with gauze pads and medical tape, and resuscitation was initiated. He was then transported to a regional hospital hemodynamically unstable, requiring further resuscitation with blood products. After stabilization, a computed tomography scan revealed bilateral hemopneumothoraces and the tip of the knife lodged in the lower lobe of the left lung. The hemopneumothoraces were drained and the patient was transported to our trauma center in the prone position, spontaneously breathing with the weapon in situ. The patient was proposed to undergo thoracic surgery, specifically an exploratory thoracotomy in the right lateral decubitus position. Airway approach plan A involved anesthetic induction in the prone position while maintaining spontaneous ventilation and placement of an AuraGain™ (Ambu, Denmark) laryngeal mask airway (LMA), followed by fiberoptic guided intubation through the device. Due to glottic edema and inability for glottic progression of the fibrescope, the AuraGain® LMA was replaced by an iGel® (Intersurgical, UK) LMA, and fiberoptic-guided intubation was successfully achieved. After surgery, the patient remained in the intensive care unit and was successfully extubated five days later. We acknowledge that alternative solutions could have been applied to this case, and we discuss some of them further in this text. This case highlights that, in such complex scenarios, clinical experience and comprehensive knowledge of various airway management devices are critical. Nevertheless, certain principles remain universal in difficult airway management, including the preservation of spontaneous ventilation and meticulous but flexible planning.

从倾向到准备:穿透性胸外伤患者的气道管理。
穿透性胸外伤后的围手术期和重症监护管理是一项复杂的挑战。那些在早期创伤治疗中幸存下来并活着到达医院的人,往往仍处于危急状态,伴有心肺系统并发症和严重的肺部损伤。额外的困难来自于原位存在武器,特别是在背部位置,这限制了患者的定位,以及武器和患者的安全操作。我们提出的情况下,一个47岁的男子,谁遭受了刺伤袭击,导致深背胸伤口与刀仍然在原位。病人最初由院前小组治疗,用纱布垫和医用胶带稳定了武器,并开始复苏。随后,他被送往一家地区医院,血流动力学不稳定,需要用血液制品进一步复苏。稳定后,计算机断层扫描显示双侧气胸和刀尖卡在左肺下叶。引流血气胸,将患者以俯卧位运送至创伤中心,将武器放在原位进行自主呼吸。建议患者接受胸外科手术,特别是在右侧侧卧位进行探索性开胸手术。气道入路方案A包括俯卧位麻醉诱导,同时保持自发通气,并放置AuraGain™(Ambu, Denmark)喉罩气道(LMA),随后通过该装置进行光纤引导插管。由于声门水肿和纤维镜下声门无法进展,我们将AuraGain®LMA替换为iGel®(Intersurgical, UK) LMA,并成功实现了光纤引导插管。手术后,患者留在重症监护病房,五天后成功拔管。我们承认,本可以对这一案件采用其他解决办法,我们在本文中进一步讨论其中一些办法。本病例强调,在如此复杂的情况下,临床经验和各种气道管理设备的综合知识至关重要。然而,在困难的气道管理中,某些原则仍然是普遍的,包括保留自发通气和细致但灵活的计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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