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Attempted suicide with a crossbow.
X Dubernard1, C Dutheil2, V Legros3
1Université de Reims Champagne-Ardenne, UFR Médecine, 51, rue Cognac-Jay, 51100 Reims, Champagne-Ardenne, France; Unité de chirurgie ORL et cervico-faciale, 51, rue Cognac-Jay, 51100 Reims, Champagne-Ardenne, France.
European Annals of Otorhinolaryngology, Head and Neck Diseases
|January 27, 2020
Summary
Airway management in head and neck crossbow injuries is challenging. Successful management involved conscious bolt removal followed by intubation, a novel approach for this rare suicide attempt.
Area of Science:
- Emergency Medicine
- Surgical Airway Management
- Trauma Surgery
Background:
- Airway management and hemorrhage control are critical in head and neck suicide attempts.
- Crossbow-related suicide attempts present unique and previously unreported airway challenges.
- Patient presentation necessitates tailored airway strategies.
Observation:
- A conscious patient attempted suicide with a crossbow to the head.
- A contrast-enhanced CT scan revealed no vascular, ophthalmological, or neurological lesions.
- The submental entry wound spared critical vascular and neural structures, but caused mechanical trismus, limiting neck access.
Findings:
- Standard intubation techniques (orotracheal, nasotracheal) and tracheotomy were difficult due to bolt position and trismus.
- A novel approach of conscious, on-table bolt removal was performed.
- Rapid intubation post-removal was achieved without complications.
Implications:
- This case highlights the need for adaptable airway management in rare head and neck trauma.
- Conscious removal of penetrating objects may be a viable strategy in specific scenarios.
- Successful airway control is contingent upon glottis visualization, bolt trajectory, and anterior neck access.