[ender18d]

Thanks for posting the scenario!

I'm approaching the scenario as an 18D Q'd language school student.

(Note that I'm assuming from the pic that there is no major vessel compromise. Its also difficult to tell the exact anatomical position, but it appears that the wound is directly inferior to cricoid membrane....?).

BSI, Scene safe, MOI, C-spine, etc.....

OK, so there is a high index of suspicion for multiple shrapnel type injuries, so I'm going to be keeping an eye peeled for big bleeds etc..., but airway damage is the obvious life threat. While having someone maintain C-spine, I'd do my best to determine patency status of the trachea.

Everything boils down to a judgement call as to how close that glass is to the trachea itself. If the trachea is compromised, then the offending glass represents both a potential obstruction and a danger to any ET-tube/bulb that I might introduce. If the piece is extremely close to piercing the trachea, I'd remove it for the same reason. If I feel comfortable that stabilization will prevent tracheal rupture (the glass has some clearance from trachea and major vessels, which I believe is highly unlikely based on the pic... so this is more hypothetical), then I would stabilize it, maybe using a wrap of casting fiberglass (I've never seen it done, but wondered about this use for fiberglass). The wrap would be around the object but NOT a circumerential neck wrap.

I'd want to intubate/cric/trach (RSI PRN), in that order of preference, to ensure that my bulb seal reaches below the wound site. Its essential if there is a chance of tracheal rupture to seal the airway with the bulb below the wound site. Otherwise, the airway may no longer be patent, and the possibility exists for aspiration of continued bleeding. If I'm not removing the glass, intubation comes before stabilization.

02, BVM (PRN), finish surveys and bandaging/packaging/supportive care including IV's, and evac ASAP with any C-spine precautions I have or could improvise. I'm going to be watching the indicator-bulb like a hawk to ensure that no shards have wreaked havoc on my bulb.