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Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/525

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Title: Airway management in a patient with nuchal, interspinous, and flavum ligament rupture by a sickle: a case report
Authors: Sorimachi, Kotaro
Ono, Yuko
Kobayashi, Hideo
Watanabe, Kazuyuki
Shinohara, Kazuaki
Otani, Koji
Affiliation: 救急医療学講座
Source title: Journal of medical case reports
Volume: 10
Start page: 172
Issue Date: 13-Jun-2016
Abstract: Background: Penetrating neck injury is an important trauma subset but is relatively rare, especially when involving the posterior cervical column. Rupture of the neck restraints, including the interspinous and flavum ligaments, can create serious cervical instability that requires special consideration when managing the airway. However, no detailed information regarding airway management in patients with profound posterior neck muscle laceration and direct cervical ligament disruption by an edged weapon is yet available in the literature. Case presentation: A 63-year-old Japanese man attempted to cut off his head using a sickle after drinking a copious amount of alcohol. On admission, his posterior vertebral column was grossly exposed and the lacerated tissues were actively bleeding, resulting in severe hypovolemic shock. We used a rapid-sequence intubation technique with direct laryngoscopy while manual in-line stabilization of his head and neck was maintained by several people. Surgical exploration revealed nuchal, interspinous, and flavum ligament rupture between his fourth and fifth cervical vertebrae, but no injury to the great vessels was present. The major source of bleeding was a site of oozing from his trapezius and splenius muscles. After surgical hemostasis, wound repair, and subsequent intensive care, our patient was discharged home without any neurological sequelae. Conclusions: Deficits of the neck restraints can cause cervical spine subluxation and dislocation secondary to neck movement. Thus, the key to successful airway management in such a scenario is minimization of neck movement to prevent further neurological impairment. We successfully managed an airway using a conventional but trusted endotracheal intubation strategy in a patient with multiple traumas and a suspected spinal cord injury. This case also illustrates that, even when great vessel injury is absent, severe hypovolemic shock may occur after profound neck muscle laceration, requiring immediate surgical intervention.
Publisher: BioMed Central
language: eng
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/525
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/525/1/JMedCaseRep_10_172.pdf
ISSN: 1752-1947
DOI: 10.1186/s13256-016-0957-9
PubMed ID: 27292101
Related Page: http://dx.doi.org/10.1186/s13256-016-0957-9
Rights: © 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Rights: http://creativecommons.org/licenses/by/4.0/
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JMedCaseRep_10_172.pdf1.17 MBAdobe PDFDownload

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