Barbieri et al. USE OF THE LMA IN POLYTRAUMATIZED PATIENTS
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patient’s head was lying between a pole and the guard-rail.
In order to avoid moving the head or neck, manual in-line
stabilization of the neck was applied by a paramedic, and the
physician, who was lying alongside the patient, positioned a
number 4 LMA. A cervical collar was then applied and with
log-roll technique, the patient was positioned on the spinal
board.
After volume replacement and ventilation with oxygen,
the arterial pressure reached 120/70 mm Hg with an HR of
80 beats/min and an SaO2 of 96%.
CASE 2
A 20-year-old man ran off the road while driving his car,
which capsized in a ditch. He showed concussive cranial
trauma, GCS 4, an open fracture on the right upper limb,
BP 100/65 mm Hg, HR 110 beats/min, and SaO2 97%.
Considering the patient’s position and the dynamics of the
accident, an injury to the spine was suspected (though not
confirmed by the subsequent diagnostic investigations). A
size 5 LMA was placed, and inflated with 30 mL of air.
Adequate saturation and ventilation were provided for more
than 20 minutes until the patient was extricated with a cer-
vical collar, KED, and spinal board. After the patient was
placed in the ambulance, two IV catheters were placed,
fluid therapy was started, and the LMA was replaced with
an orotracheal tube by means of laryngoscopy and manual
in-line stabilization of the cervical spine.
Four days after surgery to stabilize the cervical vertebrae,
the patient was transferred to the surgical ward without
evidence of aspiration pneumonia or any neurologic dam-
age.
CASE 5
A 25-year-old man, weight 80 kg, height 180 cm, was
involved in a head-on collision with another car. He was
found in a ditch, lying on his side, the most seriously
injured of the victims. When the SUEM medical car
arrived, he was in a coma (GCS 6) and needed immediate
intubation. The patient was trapped in his car and, waiting
for the Fire Brigade to arrive and free him, the physician
squeezed into the capsized car alongside the patient and
positioned a number 5 LMA. After 25 minutes the patient
was removed to the ambulance stretcher with a KED, cervi-
cal collar, spinal board, and peripheral IV catheter. Arterial
saturation was good (97%), BP was stabilized at about
100/55 mm Hg, and the HR was 98 beats/min.
On arrival at the emergency ward, a CT brain investiga-
tion showed multiple cerebral contusions with significant
edema. Fractures were identified in the following positions:
5th, 6th, and 7th right ribs, right clavicle, right humerus,
and right femur. On arrival at the intensive care unit, the
medical staff positioned an orotracheal tube. After eight
days the patient was transferred to the ward, with stabi-
lized fractures, and without neurological damage.
Sixty days after the trauma, the patient was discharged
from the hospital without neurologic sequelae.
CASE 3
A 40-year-old man was involved in a road accident, with
the car ending up in a ditch. The SUEM medical car arrived
on scene before the Fire Brigade. The patient showed BP
110/70 mm Hg, HR 95 beats/min, SaO2 92%, GCS 5,
head–facial trauma, thoracic trauma, and a fractured left
shoulder. It was impossible to open the driver’s door and the
patient could be reached only through the side window.
Therefore, a number 5 LMA and an IV catheter were placed
through the window, thus ensuring good oxygenation and
ventilation until the arrival of the Fire Brigade. With their
help it was possible to open the back door of the car and
extricate the patient with a cervical collar, KED, and spinal
board. In the ambulance, the LMA was replaced with an
orotracheal tube. The CT and other radiological investiga-
tion carried out at the emergency ward confirmed the trau-
mas: a frontal cerebral contusion, a Le Fort II fracture, and
fractures of left ribs 4 through 6 and the left shoulder.
After 32 days the patient was discharged without neuro-
logical damage.
CASE 6
A 44-year-old man fell from a 6-meter height while cleaning
the windows of the office where he was employed as a clean-
er. When the SUEM medical car arrived, his condition
appeared very serious: concussive cranial trauma (GCS 7),
abdominal trauma, open fracture to right femur, and a
lesion to left femoral artery.
The patient lay with his head in a small space between a
very heavy concrete flower pot and the wall of the building.
A number 5 LMA was placed by standing in front of the
patient. The patient was stabilized and the bleeding at the
left femoral artery was controlled, IV lines were inserted in
two large peripheral veins, and an adequate volume fill was
carried out. After being immobilized with a cervical collar,
spinal board, and head immobilizer, the patient was placed
in the ambulance, where the femoral bleeding from the lower
right limb was blocked with ropivacaine. Blood pressure
CASE 4
A 35-year-old man, weight 70 kg, height 175 cm, was a
restrained passenger involved in a rollover motor vehicle
accident. After a head-on collision with a heavy vehicle, the
patient was thrown out of his car and found in a ditch on
the opposite side of the road at a distance of more than 10
meters. He showed: GCS 8, concussive cranial trauma, sus-
pected medullar lesion, lower right limb compound fracture,
fracture of the pelvis, bradypnea, suspected fractures of the
ribcage, BP 70 mm Hg systolic, diastolic pressure undetect-
ed, and HR 130 beats/min.
The dynamics of the accident suggested a lesion of the cer-
vical vertebrae with fair certainty (as later confirmed by a
CT investigation). Intubation was very difficult: the