He was then premedicated with midazolam and fentanyl prior to any intubation attempts. 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 breathing spontaneously, and the physical examination revealed multiple midface fractures, significant bloody secretions from the oronasopharynx, and a Mallampati class IV airway. The patient was transported directly to the operating room with a cervical spine collar in place for emergent intubation and control of nasal hemorrhage. A computerized tomography scan performed in the emergency room showed the screwdriver to be penetrating through the maxilla and entering the clivus with the tip in the prepontine cistern. No loss of consciousness or other bodily injuries were noted. The patient was agitated, confused, and intoxicated. This manuscript adheres to the applicable Case Report (CARE) guidelines for case reports.Ī middle-aged male with an unknown past medical history presented with an impaled screwdriver within the left maxilla immediately adjacent to the nose. Written consent was obtained from the patient and a Health Information Portability and Accountability Act (HIPAA) authorization form was completed.
Here, we present a case of an impaled foreign body to the face and our approach to airway management of this patient. However, there is no current consensus amongst the anesthesia community on airway management of penetrating maxillofacial injuries and much variability exists. Oral endotracheal intubation with rapid-sequence induction and in-line stabilization of the neck is the gold standard in general trauma patients. Effective pre-oxygenation prolongs the time that the patient can tolerate apnea, which can be crucial for intubation of an anticipated difficult airway in these patients. Bag-mask ventilation and endotracheal intubation are predicted to be challenging in a patient with maxillofacial trauma. Other major concerns in these airways are the other potentially unknown injuries to the cervicofacial vasculature, teeth, cervical spine, and brain tissue. Nasal bleeding can obscure the airway and the laryngeal and/or tracheal swelling can displace the epiglottis, arytenoid cartilages, and vocal cords, making for difficult visualization and increasing the risk of airway compromise. Hemorrhage and soft tissue edema may lead to airway obstruction. Penetrating facial trauma can present without a compromised airway, but some cases present major challenges with disruption of airway anatomy. Our research will give you all the information on the history, current, and future fate of the sector in question. This study would certainly provide you with an unmistakable glimpse into any particular business fact without having to refer to any other research paper or source of knowledge.
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