Airway management in self-inflicted gunshot wounds to the face

Abstract

• Self-inflicted GSWs to the face may compromise a patient's airway and mental status. • Patients that can protect their airway may be managed with non-invasive support. • Supraglottic airways may be an alternative to endotracheal intubation in select cases. This study characterizes the prehospital and trauma bay airway management of self-inflicted gunshot wounds (SI-GSWs) to the face. We reviewed SI-GSWs to the face from 2017 to 2021. Patients with isolated temporal GSWs were excluded. Emergency Medical Services (EMS) and trauma bay information on airway management were collected. 38 patients presented with a SI-GSW to the face. 20 of the 29 transported by EMS were managed without advanced airways. There were four endotracheal intubations, three supraglottic airways, and two failed intubations. Those with advanced airways had lower GCS (3 vs. 15, p <0.01) and systolic blood pressure (94 vs. 144, p <0.01). After hospital arrival, 22 SI-GSWs were endotracheally intubated in the trauma bay and two in the OR. No cricothyroidotomies were performed. A majority of SI-GSWs to the face can be managed by EMS using noninvasive support. Supraglottic airways may be an option for those requiring invasive support.