Citation

Dubernard X, Dutheil C, Legros V. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2020; ePub(ePub): ePub.

Affiliation

Université de Reims Champagne-Ardenne, UFR Médecine, 51, rue Cognac-Jay, 51100 Reims, Champagne-Ardenne, France; Réanimation Chirurgicale et Traumatologique, Trauma Center, 51, rue Cognac-Jay, 51100 Reims, Champagne-Ardenne, France.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.anorl.2020.01.005

PMID

31982362

Abstract

INTRODUCTION: Airway management and control of bleeding are essential aspects of the management of attempted suicide involving the head and neck. Attempted suicide using a crossbow is exceptional. The patient's respiratory status, the position of the crossbow bolt in the head and neck, the type of bolt and its exit wound required airway management that has not been previously reported in the literature. CASE REPORT: This conscious patient had attempted suicide by shooting a crossbow bolt to the head. The radiological assessment (contrast-enhanced CT scan) did not reveal any vascular, ophthalmological or neurological lesions. The submental entry wound of the bolt avoided any damage to the lingual and ethmoidal arteries, lamina papyracea, or frontal lobe. The bolt induced mechanical trismus and its position limited access to the base of the neck, preventing orotracheal intubation. Nasotracheal intubation and primary tracheotomy were also difficult in this situation. It was therefore decided to remove the bolt while the patient was still conscious, rapidly followed by intubation, with no complications.

CONCLUSION: In attempted suicide by crossbow involving the head and neck, airway management depends on the possibility of exposure of the glottis, the bolt exit wound and safe access to the anterior neck.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Language: en

Keywords

Acute respiratory distress; Attempted suicide; Crossbow trauma; Nasotracheal intubation; Orotracheal intubation; Tracheotomy