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A case report (facial trauma)
1. A Case Report of Facial Trauma
Gholamreza
Ghamatzadeh M.D
Boardman of Anesthesiology
Poursina Hospital - Rasht
2. Presentation
Male
25 years old
BW ≈ 80kg
Severe facial trauma due to car accident
Agitated & Disoriented
GCS = 8/15
Left side chest tube
↓ Respiratory sounds in right side of the chest → suspect to
right side pneumothorax
SBP=60mmHg, DBP=non sense, HR=140/min, RR=25/min
24. New Problem
In the end of surgery:
Emphysema in left side of upper chest and
neck + Air bubbling from left side wound of
neck
↓
Second Surgical Consultation
25.
26. In the end of surgery:
BP: 80/50 mmHg
PR: 140 beats/min
Urine out put: 1500 ml for 4 hours
Transportation to ICU
33. Compromised Airway 1
Unlike difficult intubations in normal airways,
patients with compromised airways must not
be given GA or muscle relaxants unless
control of airway is ensured.
Attempt at awake intubation should not be
done “blindly” in patients with uncertain
pathologic processes.
34. Compromised Airway 2
Safe techniques for managing compromised airways
include:
1.
Awake direct laryngoscopy after careful topical
laryngeal block
2.
Spontaneous breathing using an inhaled anesthetic
3.
Awake fiberoptic evaluation of the airway
4.
Tracheostomy under local anesthesia
5.
If necessary, lifesaving TTJV through a cricothyroid
puncture with a large-caliber(14-gauge) needle, or an
emergency cricothyroidotomy.
35. Facial Injury
The most common fractures involve the mandible
and midface (Le fort I,II,III)
A first priority is to secure the airway by placing the
patient in the lateral position, pulling the mandible or
maxilla forward and clearing the oropharynx of blood
or loose teeth.
If this action is not successful, endotracheal
intubation or emergency tracheostomy should be
considered.
These patients may also have head trauma or
fractures of the cervical spine.
36. Contraindications of Nasal Intubation
Coagulopathy
Severe intranasal disorder
Basilar skull fracture
Presence of a CSF leak