颈椎刺伤后头部旋转 30° 快速插管。病例报告。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2024-10-28 DOI:10.1016/j.ijscr.2024.110498

Ichraf Ardhaoui , Oumayma Chbeb , Lotfi Rebai

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引用次数: 0

摘要

导言和重要性：颈椎外伤患者的气道管理通常具有挑战性，尤其是涉及插管时：我们的急诊科接诊了一例罕见的颈椎后外侧钝性外伤病例，患者是一名 19 岁的年轻人。初步检查发现 GCS = 15/15，无运动或感觉障碍。患者头部轻微左旋 30°，血液动力学和呼吸稳定，禁食。患者被直接送往神经外科手术室进行探查。患者只能在辅助下进行体位摆放；患者取仰卧位，头部左转 30°，固定在马蹄形头枕上。我们选择 LMA Factrach 进行插管，以确保患者获得最佳通气效果。结果令人满意，第一次尝试就成功插管：临床讨论：颈部外伤患者的气道管理通常具有挑战性，尤其是涉及插管时；在刺伤病例中，保持头部中立位并不总是可行的，因为尖锐物体的进入点通常决定了头部的位置。在非标准体位进行插管更具挑战性，通常会导致喉镜视野较差。这可能会造成喉镜视野质量与气管插管难易程度之间的脱节。清醒状态下的纤维鼻气管插管仍是困难插管病例的黄金标准，但通气标准和体位都不标准。一些科学协会建议在没有困难通气标准的情况下，将视频喉镜作为困难插管的一线方法。然而，没有此类标准并不能保证麻醉诱导后的有效通气，这就需要使用喉罩作为辅助措施来确保氧合。LMA Fastrach 可为随后的插管过程提供便利，尤其是在胃部未饱满的情况下。我们选择了 LMA Fastrach，以确保患者获得最佳通气效果。结果令人满意，第一次尝试就成功插管：当头部无法保持中立位时，LMA Fastrach 似乎是一种非常有用的气道管理工具。

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Fasttrack intubation with the head rotated 30° following a cervical stab wound. A case report

Introduction and importance

Airway management in patient with cervical trauma is often challenging, especially when it involves intubation.

Case presentation

An uncommon case of posterolateral blunt traumatic cervical spine injury was seen in our emergency department following an assault on a 19-year-old young man.

The only point of impact was cervical, the initial examination found a GCS = 15/15, no motor or sensory deficit.

The head was slightly rotated 30° to the left, the patient was hemodynamically and respiratorily stable, he was fasting.

The patient was directly transported to the neurosurgery operating room for exploration. Positioning could only be achieved with assistance; the patient was placed in the supine position, head turned 30° to the left, secured in a horseshoe-shaped headrest.

We chose the LMA Factrach for intubation to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt.

Clinical discussion

Airway management in patient with cervical trauma is often challenging, especially when it involves intubation; maintaining the head in neutral position is not always feasible in cases of stab wounds, as the entry point of the sharp object often determines the head's position.

Intubating in non-standard positions is more challenging and often leads to poorer laryngoscopic visibility. This can create a disconnect between the quality of the laryngoscopic view and the ease of performing endotracheal intubation.

Awake fiberoptic nasotracheal intubation remains the gold standard in cases of difficult intubation with difficult ventilation criteria and nonstandard positioning.

Several scientific societies recommend videolaryngoscopy as the first-line approach for difficult intubations in the absence of difficult ventilation criteria. Nonetheless, the absence of such criteria does not guarantee effective ventilation following anesthetic induction, which necessitates the use of the laryngeal mask as a secondary measure to ensure oxygenation. The LMA Fastrach can facilitate the subsequent intubation process, particularly in situations where the stomach is not full.

We chose the LMA Fastrach to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt.