weWe received a patient with severe facial trauma in our ED induring the evening shift of 17 Dec,. I was in charge of that shift.
The nurse pushed the patient directly to Trauma Bay1 room, and I came and assessassessed the patient,. I found a young man in a forward sitting position with severe facial trauma and blood covering his face totally,. I askasked the nurse to activate the trauma team stat and I specifyspecified the anesthesia doctor to come quickly for help (difficult intubation).
atAt the same time, I assessassessed the patientpatient's airway: the patient can'tcouldn't communicate and he can'tcouldn't handle his secretion ( active bleeding from mouth and nose )nose), he also he can'tcouldn't open his eyes (GCS;? 8-9 ) he was agitated.
I asked for RSI medication, and C-Mac+ direct laryngoscopy + bogey. andThe anesthesia doctor came at that time and he assessed for possible cricothyrotomy.
afterAfter a quick discussion with the anesthesia doctor who was standing with me, he advised for a full RSI intubation.
patient Patient was vitally was stable at that time.
thereThere was a big upper lip laceration with some teeth not in place (?upper 3-4 teeth ),. I started with C-Mac with suction, but there iswas active bleeding, and even with good suction there isit was difficult to view (full of blood),. I then I trytried with direct a laryngoscope "with good suction" alsoagain it was difficult to view ( full of blood even with active suction), afterand after multiple suction,suctioning I saw a small part of the vocal cord, but I didn't see any tooth or forging body, then. Then I passed the tube and post-intubation management started).
trauma Trauma team (mainly general surgery ) and anesthesia staystayed and continuecontinued with the patient, I telltold them I willwould leave for managingto manage the busy ER.