suicidal cut throat injury

1. Suicidal cut throat injury
MODERATOR: Dr.K.V.Chidananda
Presentator: Dr.Veerandha reddy.v

2. • A 52 year old male patient brought to the ER
department with self inflicted anterior neck
wound from a suicidal attempt on 30/10/2016
at 4.30pm ,
• On receiving, patient’s vitals are:
• Pulse:68 bpm,
• BP: 110/70 mm of hg,
• RR:20cpm, Spo2:98 mm of hg,

3. • There was an antecedent history of psychiatric
illness for which he was not receiving any
treatment.
• No history of substance abuse,

4. • On examination Patient is conscious, he was not
in respiratory distress, while on deep inspiration
gush of air leak seen,
• Able to talk normally,
• An 12 cm transverse anterior neck laceration
with hesitant cut on right side, and it was deeper
on the left (probably used left hand ) and seemed
to be at the level of the thyrohyoid membrane.
The sternocleidomatoid muscles and carotid
sheaths were unaffected,

6. • The chest was clinically clear.
• we made a diagnosis of suicidal cut throat with
tracheal injury, and started Resuscitation:
• A&B-airway maintained with emergency
intubation,
• C- Intra Venous line secured with a large bore
canula (18G) and started on RL and blood send
for routine investigations,

7. • Planned for emergency surgery:

8. • Intraoperatively

15. • Post operatively patient was stable,
• No surgical emphysema, no dyspnoea,
• Patient had alcohol withdrawal symptoms and
managed conservatively with inj serinase and
tab.librium,

16. • On pod 10 sutures removed, patient
discharged after psychiatric consultation.

17. DISCUSSION:
anatomy of neck

18. NECK
• The neck is a tube providing continuity from
the head to the trunk. It extends anteriorly
from the lower border of the mandible to the
upper surface of the manubrium of the
sternum, and posteriorly from the superior
nuchal line on the occipital bone of the skull
to the intervertebral disc between the CVII
and TI vertebrae.

19. Within the tube, four compartments provide
longitudinal organization
1. The visceral compartment is anterior and
contains parts of the digestive and respiratory
systems, and several endocrine glands .
2. The vertebral compartment is posterior and
contains the cervical vertebrae, spinal cord,
cervical nerves, and muscles associated with the
vertebral column.
3&4. The two vascular compartments, one on each
side, are lateral and contain the major blood
vessels and the vagus nerve [X] .

20. Discussion:
• Cut-throat injuries (CTIs) are defined as incised
injuries or those resembling incised injuries in the
neck inflicted by sharp objects. This may result
from accident, homicide, or suicide.
• CTIs are potentially life threatening because of
the many vital structures in this area. These
patients need emergency and multispecialty care.
• In this part of the world, suicide is the major
cause of CTIs.

21. ETIOLOGY:
• young men from rural areas were most
susceptible to CTIs. The leading cause of a CTI
was a suicide attempt. Among patients who
attempted suicide, the reason was psychiatric
illness most of the times.

22. • Exposed hypopharynx and/or larynx following
a cut throat, hemorrhage, shock, and asphyxia
from aspirated blood are the most common
causes of death following a CTI.
• Prevention of these complications depends on
immediate resuscitation by securing the
airway by tracheostomy or by intubation.

23. • Assessment of patients with CTI begins with
the ABCs of resuscitation, that is, checking the
airway, and evaluating the patient’s breathing
and circulation. Resuscitation should be
commenced immediately.

24. • If active and severe bleeding is occurring it is
often possible to control the vessel by placing
an artery forceps on it.
• An intravenous infusion is an early priority and
blood should be taken for immediate blood
grouping and cross matching.

25. • Respiratory difficulties may arise in several
ways :
• (1) The severed and mobile base of the tongue
may obstruct the laryngeal inlet and this can
usually be temporarily relieved by placing the
patient in a semi-prone position.

26. • (2) Damage to the laryngeal inlet may cause
acute oedema. This is a dangerous situation
and must be relieved quickly by either passing
an endotracheal tube orally or through the
neck wound,if this is impossible a
tracheostomy must be performed.
• This is one of the few occasions when an
emergency tracheostomy may be justifiable
and life saving.

27. • (3) bleeding directly into the trachea if the
wound is below the level of the cords. A
cuffed tracheostomy or magill endotracheal
tube can be directly inserted through the
wound so as to limit the amount of blood the
patient inhales.

28. • (4) laryngeal spasm due to blood or saliva
irritating the larynx or due to injury to the
recurrent laryngeal nerves can produce acute
asphyxia. If it is due to the former, correct
positioning of the patient with suction
clearance of the oro-pharynx is usually all that
is necessary but if due to the latter the
insertion of a tracheal tube is the safest
measure.

29. • The operative procedure consists of
exploration of the wound, ligation of damaged
vessels and the repair of damaged structures.

30. POST OPERATIVE CARE:
• Post-operatively a course of antibiotics should
be given to prevent wound infection and the
development of a perichondritis and lung
infection.
• Fluid balance must be attended to because
dehydration can occur due to excessive loss of
saliva and the inability to swallow normally.

31. • The lungs must be cared for by humidification
of the inspired air and regular aspiration of
the trachea aiid bronchi; suction is especially
necessary if tracheo-bronchial soiling has
occurred.
• The cuff of the tube should be released at
regular intervals after suction clearance of the
oro-pharynx.

32. •THANK YOU