SAQ 302 – Retrieval Medicine – penetrating floor-of-mouth injury

Retrieval Medicine – penetrating floor-of-mouth injury.

a. Findings and acute complications

• Metallic foreign body entering the submandibular region.
• Penetrates the floor of mouth without obvious hard-palate penetration.
• Left-sided object displacing the tongue to the right.
• No obvious bony or airway injury on the provided images.
• Immediate risks include airway obstruction from bleeding, swelling, tongue displacement, or inability to ventilate.
• Other acute concerns include haemorrhage/vascular injury and aspiration.

b. Transport comparison

c. In-flight options

• Insert a supraglottic airway such as a size 3 or 4 LMA; it may allow oxygenation/ventilation but is not definitive.
• Perform a surgical airway if LMA fails or as the primary rescue option; the foreign body position should not prevent success, although the aircraft environment makes it harder.
• Endotracheal intubation is unlikely to be achievable given the foreign body and aircraft constraints.