Airway Management of Penetrating Facial Trauma from an Impaled Screwdriver: A Case Report

Suman Rajagopalan

doi:10.32474/gjapm.2020.03.000173

Abstract

Penetrating facial trauma can present without a compromised airway, but some cases present major challenges with disruption...

Highlights

Penetrating facial trauma can present without a compromised airway, but some cases present major challenges with disruption of airway anatomy
Bag-mask ventilation and endotracheal intubation are predicted to be challenging in a patient with maxillofacial trauma
Written consent was obtained from the patient and a Health Information Portability and Accountability Act (HIPAA) authorization form was completed

Summary

Introduction

Penetrating facial trauma can present without a compromised airway, but some cases present major challenges with disruption of airway anatomy. The patient was transported directly to the operating room with a cervical spine collar in place for emergent intubation and control of nasal hemorrhage. He was breathing spontaneously, and the physical examination revealed multiple midface fractures, significant bloody secretions from the oronasopharynx, and a Mallampati class IV airway. The location of the screwdriver prohibited bag-mask ventilation, so the patient was pre-oxygenated with a nasal cannula at 10 L-min-1 of oxygen. He was premedicated with midazolam and fentanyl prior to any intubation attempts.

Discussion

Conclusion