Because the SpO2 was optimal and the cuff of the iLMA was judged to be preventing further aspiration of blood, no attempt was made to intubate the patient via the iLMA either at the scene or on the journey to hospital. Intermittent positive pressure ventilation (IPPV) was applied by means of a bag-valve device fitted with an oxygen reservoir, and the patient's SpO2 rose steadily to 100%. While still trapped in a sitting position, the patient was sedated with midazolam (5 mg IV bolus) and an iLMA was inserted without difficulty. However, it proved difficult to prevent aspiration of blood from his facial injuries despite frequent suctioning of the airway, and the patient became combative as his SpO2 level dropped to 80%. He was breathing spontaneously and his SpO2 was initially maintained around 95% by means of high-flow oxygen administered via a nonrebreathing mask (NRBM). The first paramedics at the scene found that he responded to painful stimuli but not to verbal commands with a Glasgow Coma Score (GCS) of 8 (eyes 1, motor 5, verbal 2). He sustained serious head and facial injuries and was trapped in a sitting position for 60 minutes.
#Marty stuart neck injury driver
This 58-year-old male was the driver of a car which collided with a truck. Where patients were intubated via the iLMA, a flexible, reinforced tracheal tube with an atraumatic tip designed specifically for use with the iLMA (Euromedical Industries, Kedah, Malaysia) was employed on each occasion. All patients were continuously monitored by pulse oximetry and capnography using a Capnocheck II device (Smiths Industries Medical Systems, Wis, USA).
In some cases, this hypoxaemia was accompanied by an inability to prevent aspiration of blood by regular suctioning of the airway. The principle reason for use of the intubating laryngeal mask airway (iLMA or LMA Fastrach - LMA North America Inc., San Diego, Calif, USA) in these cases was an inability to establish or maintain adequate oxygenation (defined as a pulse oximetry reading of at least 90%) using basic airway techniques such as opening the airway, insertion of an oropharyngeal or nasopharyngeal airway (or both) and the administration of high-flow supplemental oxygen therapy via a nonrebreathing mask or a bag-valve-mask ventilation device. The study group consisted of consecutive trapped patients with severe polytrauma who presented over a period of nineteen months.
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