PENETRATING HEAD INJURY IN A CHILD – A CHALLENGING AIRWAY MANAGEMENT
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Abstract
Traumatic head injury could lead to morbidity as well as mortality. Airway management is also a topic of debate in such cases. In this case, a 17-month-old child presented in A and E department of Dow University of Health Sciences, Karachi with a toy car wheel penetrated in his occiput region. His craniectomy was planned to remove the foreign body and required securing of airway for anesthesia purpose. In terms of airway management, endotracheal intubation via rapid sequence intubation has been proved as a gold standard mean in trauma cases. Clinical literature has also reported early use of indirect methods such as fiber-optic laryngoscopy or video laryngoscopy as mean of easy placement of endotracheal tube with lesser complications.
A number of difficulties were faced during this case, site of injury being the major one. The impacted toy wheel on occiput region made it difficult to lie child on flat surface and limited extensive manipulation. Other than that, lack of advanced equipment and unavailability of pediatrics anesthetist were also contributing factors. With simple positioning maneuvers, we were able to secure child’s airway without any further complications
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Hubba Ahmed
FCPS, MBBS, Senior Registrar, Department of Anaesthesiology, Dow University of Health Sciences
Alina Mahmood
FCPS, MBBS, Senior Registrar, Department of Anaesthesiology, Dow University of Health Sciences
Maria Hashmi
FCPS, MBBS, Locum Consultant, Department of Anesthesiology, The Aga Khan University
Hira
FCPS, MBBS, Senior Registrar, Department of Anaesthesiology, Sindh Institute of Urology and Transplant
Nasra Perveen
FCPS, MBBS, Senior Registrar, Anaesthesiology, Dow University of Health Sciences
Umama Masnoon
FCPS, MBBS, Senior Registrar, Department of Anaesthesiology, Dow University of Health Sciences
Tooba Usman
FCPS, MBBS, Senior Registrar, Department of Anaesthesiology, Dow University of Health Sciences
Syed Mujeer Ahmed
MBBS, Postgraduate Trainee, Department of Anesthesiology, The Aga Khan University