Management of a massive thoracoabdominal impalement: a case report
© Abbas; licensee BioMed Central Ltd. 2010
Received: 13 September 2010
Accepted: 26 October 2010
Published: 26 October 2010
With great interest, I read the case report of Management of a massive thoracoabdominal impalement(SJTREM,2009, 17:50 (7 October 2009). The topic is interesting but the position of patient decided by the authors could have been modified so that the airway management, anaesthesia and surgery could have been made more conventional, convenient, speedy and less cumbersome.
Trauma remains a leading cause of death across all age groups, some of the injuries are dynamic and it is crucial for the Anaesthetists to have upto date understanding of Injury patterns, mechanisms, and pathophysiology to facilitate optimal management of these patients because in some cases of thoracic Impalement Injuries chances of survival are high. Early deaths are secondary to hypoxemia, airway obstruction, hemorrhage, haemothorax, cardiac tamponade and aspiration.
In this published case report the impaled iron angle was projecting in the anterior-posterior direction and the patient and iron angle were supported at all times and the authors decided to intubate the patient in semi-reclining position supported all the time by helpers, anesthetist stood on the stool to gain additional height and even left thoraco-abdominal incision needed to be given instead of conventional midline or paramedian Incision.
Peroperative management is very challenging in such cases and the position of patient is very crucial for the safe conduct of such cases. One of the options available is to place the patient in lateral position. Different authors have described the use of fibreoptic intubation is sitting position. This technique has limited value in emergency situations and may require more time than conventional laryngoscopy.
To summarize, the management of massive thoraco-abdominal impalement injuries can be made simpler by modifying the position of patient by making use of gaps in the theatre table attachments and placing the patient in conventional supine postion.
(Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)
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