Case

EMTs are responding to an emergency call to a building site. At the scene, they find a patient with acute respiratory difficulty. The EMTs observe a nail from a nail gun impaling the patients neck at the level of the hyoid bone. The left side of their face is pale and there is an expanding mass deep to the skin at the site of the nail. The patient starts to cough blood and struggles to breathe, losing consciousness.

Question 2/3 - What action should be taken?

Click on your selected option(s) below  (correct = 1,  over-thinking = 2+)

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Incorrect. The patient is in acute respiratory distress, with active significant hemorrhage. And any delay in care for advanced imaging is not warranted. 

Incorrect. A tourniquet is useful for limbs to control bleeding, but clearly in the neck it would result in all blocking blood flow to the brain and patient death within 3-5min.    

Incorrect. CPR relies upon the ability to introduce air through the upper airways to the lung. In this case, the nail through the neck appears to be impeding upper airways and, thus, could also impede air delivered during CPR.

Incorrect. While this could be useful in a hospital setting, the patient is in acute respiratory distress and any delay in care for imaging is not warranted. When the patient is more stable, an X-ray to assess the nail position would be useful prior to surgery.

Correct! The patient is experiencing acute respiratory distress and experiencing difficulty in breathing. As the nail is likely impacting the airway at the level of the hyoid bone, an emergency airway must be established via a cricothyrotomy. This opens an alternative airway at a level inferior to the nail blockage.

Incorrect. The scenario suggests that there is a nail impacting the airway at the level of the hyoid bone, inserting a tube past the sharp nail to intubate the patient runs a high risk of displacing or causing further injury from the tube impacting the nail during insertion.

Incorrect, this is a treatment for pneumothorax and would not assist with establishing breathing or hemorrhage control in this patient.