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Photo at time of admission in emergency department, showing extent of injuries
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Figure 0001: Photo at time of admission in emergency department, showing extent of injuries

Mentions: After initial resuscitation in emergency department with intravenous fluids (colloid and crystalloids) and blood transfusion patient was stabilized and suctioning of the blood from the upper airway, a closer examination of the face was done. There was comminuted fracture of mandible, maxilla, and nasal bones. Tongue, hard palate, and nasal structures were not recognizable [Figure 1]. Three loose teeth were seen embedded in the lower half of the face. The eyes were spared and his vision was unimpaired. Cerebrospinal fluid leak could not be made out because of the presence of blood. The expired gases had an exit near the root of nasal structure, which could be made out by the movement of cotton strands and no foreign body was present. The neck was not injured. Nervous system examination, as far as could be elicited, was normal with no cranial nerve damage or sensory and motor weakness. On auscultation, the breath sounds were normal with no added sounds, suggesting no aspiration of blood into trachea. Rest of the systemic examination was also normal. Chest radiograph was normal and no foreign body was present. He was scheduled to undergo emergency tracheostomy for airway management, debridement, and closure of facial laceration under general anaesthesia.[1]

Emergency intubation using a light wand in patients with facial trauma

Sahu S, Agarwal A, Rana A, Lata I - J Emerg Trauma Shock (2009)

Bottom Line: Emergency department physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists.The injuries made the patient's airway management a complex issue.We present the use of the light wand to manage the difficult airway of this patient with complex facial trauma.

Affiliation: Department of Anaesthesiology, GSVM Medical College, Kanpur, UP, India.

ABSTRACT
Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. Emergency department physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. An 18-year old male patient was brought to our emergency room after an alleged history of suicidal attempt with gunshot under the chin. He was scheduled to undergo emergency tracheotomy, debridement, and closure of facial laceration under general anaesthesia, presenting a challenge for. He had to undergo emergency tracheotomy, debridement, and closure of facial lacerations under general anesthesia. The injuries made the patient's airway management a complex issue. We present the use of the light wand to manage the difficult airway of this patient with complex facial trauma.

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