[High-risk airway management in pediatric prehospital emergency medicine]

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Trauma Surgery

Background:

• Airway management in pediatric patients with severe head and maxillofacial trauma presents unique challenges.
• Rapid sequence induction is a common approach but can be complicated by anatomical disruptions.
• Prehospital settings require efficient and effective airway control strategies.

Observation:

• A 3-year-old boy with severe head and maxillofacial trauma experienced airway obstruction and hypoxemia, necessitating tracheal intubation.
• Difficult laryngoscopy and failed intubation attempts occurred during rapid sequence induction.
• A pediatric angulated Eschmann-like stylet was successfully used to secure the airway blindly.

Findings:

• The Eschmann-like stylet facilitated tracheal intubation when conventional methods failed in a complex pediatric airway.
• Standard ventilation techniques like facemask or laryngeal mask were not feasible due to open facial wounds.
• The child recovered without neurological deficits after hospital tracheostomy.

Implications:

• This case highlights the potential difficulties of rapid sequence induction in severe pediatric maxillofacial trauma.
• It underscores the value of specialized devices like the pediatric Eschmann-like stylet in difficult pediatric airway management.
• The study suggests a need to reconsider standard protocols and emphasize training in advanced airway techniques for pediatric emergencies.