CHALLENGES OF AIRWAY MANAGEMENT IN A PATIENT WITH MAXILLOFACIAL INJURY IN A RESOURCE. POOR ENVIRONMENT
P.U. Onwuadika, A.I. Eshiet, I.UIlori, QKalu, R.A. Beshel-Akpeke, AEbeiyamba, I.E Ukpabio, F.B Ugot, J.O EnabuleleAvailable online Jun 6, 2024.
[ Report ] Volume 1, Issue 1, 2017, Pages 22-27
Abstract
Maxillofacial injuries can be frightening. It often presents with disfiguring facial appearance. These injuries usually result from high velocity trauma. Advance Life Trauma Support (ALTS) recommends that, in management of patients with Life-threatening injuries airway maintenance with cervical spine immobilization should be the first priority. Securing the airway in these patients is often difficult in spite of all modalities availablebecause these injuries are often complicated by injuries to various routes of intubation, associated C-spine injury, and high risk of regurgitation and aspiration. Difficult airway should always be anticipated and planned for. Good assessment of the injuries and careful formulation of airway management plan is very essential for better outcome.
Method: We report a 55yr old man who presented in a peripheral Hospital with scary facial avulsion involving half of the facewith associated mandibular fractures, multiple scalp lacerations and open fracture of the tibia and fibulasecondary to Road Traffic Accident (RTA)
He was transferred to this facility after being rejected by other facilities within vicinityHe was one of the few survivor of a ghastly Vehicular motor accidentHistory could not be obtained, as the patient was still confused and there was no eye witness.
Examination revealed a confused patientin painful distress, he is conscious with GCS of 13/15with active bleeding from the facial injuries, scalp, and the mouth. The Right lower limb was splinted (had Fractured Tibia and Fibular)There was no CSF otorrhea nor rhinorrhea. BP ranged between 100/60- 110/70 Pulse 110-126 bpm (after resuscitation), SPO2 96-98% (room air) with respiratory rate of 20 breaths/min, no respiratory difficulty. Airway assessment revealed multiple abrasion around the neckbleeding from the angle of the mouth, with exposed mobile, fractured, right mandible.
Urgent blood grouping and cross-matching was the only investigation one could assess.
He was premedicated with intravenous Ranitidine andMetorclopromide. Difficult airway was anticipated and planned forThough there was no Fibreoptic laryngoscope, and other visual aids of securing the airway, and no ENT surgeon within the facility, however we had Resus I-gel LMAClassic LMA, intubating bouggie, and a 16G cannular with a connectoras back upThe airway was successfully secured via nasotracheal intubation using the conventional Macintosh laryngoscope, after induction with Ketaminewith Cricoid pressure application and In-Line stabillization of the C-spine Patient had a successful surgery. Extubation was done 4days later and patient made a good recovery.
Conclusion: Airway management in Maxillofacial injuries is challenging irrespective of the environment and equipment available Clinical status and features of the trauma dictates the approach for securing the airway Various steps of difficult airway management need to be planned before airway managerment is initiated. Familiarizing with the available airway devices is necessary for better outcome as seen in this management
Keywords
Challenges. Airway management Maxillofacial Trauma. Resource poor environment,Download Article without Subscription
