Difficult Airway in a Patient with Jaw Fracture: A Case Report
Abstract
Dawood Nasir and Carl Adkins
Introduction Major trauma cases with jaw fracture are a significant airway management challenge for anesthesiologist. Awake intubation while preserving spontaneous ventilation is a very stressful situation, especially cases with preexisting psychosis.
Presentation of the Case This motor vehicle collation case was unable to open mouth due to fractures and dislocation of jaw. Case was positive for personal history of psychosis. Anesthetic plan was to incubate nasally. Due to agitation, it appears to be difficult to perform an awake nasal incubation and to anesthetize the upper airway. Decision was made to perform awake oral intubation nerve blocks to obtund the gag reflex; and three major nerves which supply airway were blocked. The tube was advanced slowly until it was certain that the tube was successfully placed in the trachea as the sound of the whistle became louder.
Conclusion The use of whistle to localize trachea is a lost art. An old trick of intubation which is being lost by technological devices could still work in a skill full hand.