Airway Trauma With Severe Oropharyngeal Bleeding
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
An 83-year-old woman was brought to the emergency department by emergency medical technicians after a fall, presenting with a blunt injury to the face with multiple visible injuries to the nose and lip and severe active bleeding from her mouth. Her cervical spine was immobilized by a cervical collar. Upon arrival, her Glasgow Coma Scale score was 6; blood pressure, 160/99 mm Hg; heart rate, 120 beats per minute; and oxygen saturation, 84% with 6 L of oxygen administered via a non-rebreather face mask. Her past medical history was significant for hypertension, coronary artery disease and atrial fibrillation. She was treated with metoprolol, lisinopril and warfarin.

Resolution of the Case

The cervical collar was removed, and the patient’s head and neck were maintained in neutral position by manual in-line stabilization. Preparations were made to perform emergent cricothyroidotomy. The attending anesthesiologist attempted intubation by video laryngoscopy using a GlideScope . No view of the glottic opening could be obtained because of continuous severe bleeding. An Intubating Laryngeal Mask Airway size 4 was inserted successfully on the first attempt. A lubricated, reinforced 7-mm endotracheal tube was passed through the ILMA and intubation confirmed by capnography. The ILMA was then removed while the ETT was retained in place. The patient was transferred to the ICU. Her international normalized ratio was 3; prothrombin complex concentrate was administered to reverse the warfarin effect. Oropharyngeal bleeding subsequently stopped, the facial lacerations were sutured, and the patient was successfully extubated after 48 hours.


Traumatic upper airway injury resulting in severe oropharyngeal bleeding is a potentially life-threatening emergency. Active oral bleeding can obscure the visualization of the anatomic structures, including the laryngeal inlet, leading to an airway crisis, especially if the patient needs to be intubated urgently. Direct, indirect (video) laryngoscopy, and fiber-optic–guided intubation may all be ineffective in this situation. Emergency front-of-neck access (FONA) is indicated if laryngoscopy is predicted to be unsuccessful.

Other methods for securing the airway in patients presenting with active oral bleeding are intubation through a supraglottic airway device (SAD), retrograde intubation and lightwand-guided intubation, to name a few.

Dr. dr t●●●i f●●●●i and 1 others like this1 share