Fasttrack intubation with the head rotated 30° following a cervical stab wound. A case report

Abstract

INTRODUCTION AND IMPORTANCE: Airway management in patient with cervical trauma is often challenging, especially when it involves intubation. CASE PRESENTATION: An uncommon case of posterolateral blunt traumatic cervical spine injury was seen in our emergency department following an assault on a 19-year-old young man. The only point of impact was cervical, the initial examination found a GCS = 15/15, no motor or sensory deficit. The head was slightly rotated 30° to the left, the patient was hemodynamically and respiratorily stable, he was fasting. The patient was directly transported to the neurosurgery operating room for exploration. Positioning could only be achieved with assistance; the patient was placed in the supine position, head turned 30° to the left, secured in a horseshoe-shaped headrest. We chose the LMA Factrach for intubation to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt. CLINICAL DISCUSSION: Airway management in patient with cervical trauma is often challenging, especially when it involves intubation; maintaining the head in neutral position is not always feasible in cases of stab wounds, as the entry point of the sharp object often determines the head's position. Intubating in non-standard positions is more challenging and often leads to poorer laryngoscopic visibility. This can create a disconnect between the quality of the laryngoscopic view and the ease of performing endotracheal intubation. Awake fiberoptic nasotracheal intubation remains the gold standard in cases of difficult intubation with difficult ventilation criteria and nonstandard positioning. Several scientific societies recommend videolaryngoscopy as the first-line approach for difficult intubations in the absence of difficult ventilation criteria. Nonetheless, the absence of such criteria does not guarantee effective ventilation following anesthetic induction, which necessitates the use of the laryngeal mask as a secondary measure to ensure oxygenation. The LMA Fastrach can facilitate the subsequent intubation process, particularly in situations where the stomach is not full. We chose the LMA Fastrach to ensure optimal ventilation for the patient. The result was satisfactory, with successful intubation achieved on the first attempt. CONCLUSION: The LMA Fastrach appears to be a very useful mean for air way management when the head cannot be kept in a neutral position.