(Warning : medical gobbledygook ahead)
I recently met a senior colleague of mine who is attached to the ETU (Emergency Treatment Unit, a.k.a. A&E) of a big hospital in Colombo. Little beads of sweat dotted my forehead as I listened to his experiences there. The trauma scenarios he described were horrifying, even though I have had a decent training at NHSL.
A few weeks ago, a youngish guy had been admitted following a road traffic accident (RTA)... a nasty collision with a train during the wee hours of the morning. While the rest of the body was ok, he had severe injuries to the head, including facial fractures that were a combination of Le Fort II and III. In other words, his facial bones were in 4 fragments... (shudder).
My friend and his team had been trying disparately to intubate the patient, as that was the only way to secure the airway and ensure he didn't aspirate from the torrential bleeding. Every time they tried to insert the ET tube, part of the face would move forward or backwards or sideways....making the task next to impossible.
That's when they decided on a radical approach, one I had never heard of before. They created an emergency tracheostomy and inserted the guide-wire of a CVP line upwards through the larynx and out of the mouth and then guided the ET tube down the wire!! I was open mouthed with admiration at whoever came up with this maneuver. Thanks to their quick action, they were able to get the patient stabilized on a ventilator.
I'm not sure what happened to the poor guy, but I hope he survived.
My applause goes to all innovative doctors out there.... for their clear headedness in the face of the seemingly impossible - a trait that saves lives.