Anju Ghai, Raman Wadhera.
Catastrophies in airway management in blunt neck trauma.
Anesth Pain Intens Care Jan ;11(2):92-3.

A 45 years old, ASA grade-I, male patient, presented to emergency department with a swelling on right side of his neck He gave history of blunt trauma to neck inflicted with a stick 8 hours ago, resulting in neck swelling which had increased gradually in size. Patient was visibly dyspnoeic with a respiratory rate of 36/minutes, however there was no stridor. Arterial blood gas analysis (BGA) showed pH 7.23, pO of 64 mmHg and pCO of 54mmHg, HCO3 20 showed a large mass on right side of neck lateral to the mmol/l at FiO of 0.4. Contrast enhanced CT neck 2 right carotid artery encasing the vessels at places. A diagnosis of rupture of internal jugular vein with massive neck haematoma was made. After careful consideration of all the relevant factors, a plan was made for awake intubation. In the operation theatre, after establishing the intravenous access with 16G cannula, monitoring for heart rate, ECG, NIBP and SpO was instituted. Injection glycopyrrolate 0.2 2 mg was given. Awake fibreoptic intubation was achieved after topical anaesthesia of oral cavity and nose with 4% viscous lignocaine. Superior laryngeal nerve block and transtracheal anesthesia were not considered feasible due to altered landmarks. Anaesthesia was induced using thiopentone and maintained with 0.8-1% isoflurane in oxygen and nitrous oxide.

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