Newly Published
Images in Anesthesiology  |   May 2020
Management of the Traumatic Airway Obstructed by Foreign Body
Author Notes
  • From the Department of Anesthesia, Emory University, Atlanta, Georgia.
  • Correspondence: Address correspondence to Dr. Hollon: mmayo2@emory.edu
Article Information
Images in Anesthesiology
Images in Anesthesiology   |   May 2020
Management of the Traumatic Airway Obstructed by Foreign Body
Anesthesiology Newly Published on May 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003344
Anesthesiology Newly Published on May 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003344
Head and neck trauma patients can present significant airway challenges requiring specialized techniques and rapid decision-making.1  This image shows a patient with a large metal foreign body impaled through her right submandibular space, hard and soft palate. She could not turn her head due to pain, and access to her neck was restricted. She was bleeding profusely from her nares and oral cavity, and was unable to control her secretions or tolerate lying back without coughing and desaturation. How should the anesthesiologist best manage this patient?
Oral intubation would have been impossible, and though emergency cricothyroidotomy or tracheostomy is often ideal in head and neck trauma,2  it was likely to be extremely difficult. Along with traditional concerns including aspiration, unique airway considerations included need for expeditious action due to bleeding and desaturation, potential intracranial injury with desire to avoid increasing intracranial pressure, potential cervical spine injury, and ability of the patient to cooperate.