Summary
Background. Craniocerebral injury is frequently associated with severe airway compromise, aspiration and respiratory failure. Emergency intubation and assisted ventilation, performed at the scene of an accident, can reduce a number of these complications, however it may be difficult, traumatic and sometimes impossible. We present a case of severe laryngeal trauma after failed emergency intubation. Case report. A 22-year-old man was found comatose (GSG 8) at the scene of a motorcycle accident. After several intubation attempts he was given 35% oxygen by mask and transported to hospital. On admission he was deeply comatose (GSG 6), but breathing spontaneously (SaO₂ 95% on 35% oxygen). Diagnosis of isolated cerebral trauma was made and the patient was taken for a CT scan, where he was given 250 mg thiopentone for sedation. Direct laryngoscopy revealed periglottic oedema and bleeding; intubation was not possible. Emergency tracheotomy was performed and mechanical ventilation instituted. The patient regained consciousness after two weeks, and a further week later, a detailed laryngoscopy was performed, revealing a partially avulsed epiglottis without laryngeal obstruction. The tracheal tube was subsequently removed and the patient discharged home. Discussion. Attempted intubation at the scene of an accident, performed in haste and without sedation, resulted in serious damage to the periglottic region, oedema and bleeding. Although emergency intubation in a patient with head trauma and GSG score below 8 has been widely recommended, it should not be attempted in an agitated or bleeding patient and/or by inexperienced personnel. When airway and/or adequate spontaneous ventilation can be secured with an oropharyngeal tube or LMA, intubation should be postponed. Emergency physicians and paramedics should be adequately trained in maintenance of the difficult airway associated with trauma.