Airway - Hard 46yo male, at church Shot in neck A Hoarse voice Air bubbling thru wound RR = 36 SaO2 = 89% 100NRB B Decreased AE x 2 C HR = 86 BP = 116/76 D GCS =15,PERL 3mm, MA4L E C-spine collar in place
Clothesline accident 14yo M 60km/hr, 30 min ago A Minor hemoptysis, mild voice hoarseness B Sao2 = 99% on 8L NP, GAEB, WOB is N CNo other bleeding, HR = 84, BP =128/84 Rest of exam is unremarkable C-spine precautions +
Case 52 yo, penetrating nail injury Immediately removed nail Bleeding controlled
Case -ABC’s are all unremarkable -No hard or soft signs -Exploration, platysma is midly violated
-CTA: Trajectory visualized and not close to vital structures. Soft tissue injury only -Pt remains very well
If it violates the platysma, trauma wants to be involved
Hanging Patient brought to rescus bay by EMS What do you want to know?
Strangulation vs hanging Judicial vs n-judicial Complete vs incomplete
ABC’s ALMA in place, bagged, good chest rise BGAEB, Sa02 = 98% CNSR, BP = 80/40 DPupils fixed at 2mm, GCS = 3 EC-spine collar in place Tardieu’s spots
On physical exam Ligature marks Tardieu’s spots Laryngo-tracheal symptoms Hoarseness, stridor, Focal tenderness or crepitation Dysphagia CNS depression from GCS 3 to nil Respiratory compromise from severe to nil
Up to 70% of hanging victims were found to be positive for EtOH or drugs
Over 90% of near-hanging victims will survive to be discharged Only 3,5% will have severe disability
Last case -28 yo F, assaulted by husband -Was strangulated -Witness states LOC ~ 1 min
79% of strangulation victims were assaulted by intimate partner
VS are normal and stable On exam, only finding is finger marks and ecchymosis of neck Who would CTA this patient?
Same patient, has minor hemoptysis and neck pain +++ on examination Who would CTA this patient now?
In summary Platysma violated = trauma consult Treat every neck trauma as a difficult airway & think ahead Know your hard & soft signs and investigate accordingly C-spine in penetrating if GSW + low GCS/neuro signs In blunt, think about BCVI In hangings: Resuscitate first, Prognosticate later* *P. M. Hodsman
Thanks Marc Francis Mike Hodsman Rohan Lall Chad Ball Monica Hoy Lee Graham