[King Herald]

That pic has been around for a while, with various explanations as to what happened.

[Sharon]

That's a colossal injury! Medic Mark is great btw

[gatagato]

The photo was published in the Journal of Emergencies, Trauma, and Shock , vol. 2, no. 1, 2009, in an article titled:
Emergency intubation using a light wand in patients with facial trauma

Case report

An eighteen-year-old male patient was brought to our emergency department five hours after an alleged history of suicidal attempt with gunshot under the chin. He was presented with a burst open face and no recognizable structures on the face, except for the eyes. He was uncooperative and drowsy. His arterial blood pressure was 80/60 mm Hg and pulse rate was 124/min. His respiratory rate was 26/min and was slightly distressed. He was unable to lie supine as the shredded structures tended to fall back; causing airway obstruction and blood trickled into the oropharynx causing him considerable distress.

After initial resuscitation in emergency department with intravenous fluids (colloid and crystalloids) and blood transfusion patient was stabilized and suctioning of the blood from the upper airway, a closer examination of the face was done. There was comminuted fracture of mandible, maxilla, and nasal bones. Tongue, hard palate, and nasal structures were not recognizable [Figure 1 (which is the one in the OP)]. Three loose teeth were seen embedded in the lower half of the face. The eyes were spared and his vision was unimpaired. Cerebrospinal fluid leak could not be made out because of the presence of blood. The expired gases had an exit near the root of nasal structure, which could be made out by the movement of cotton strands and no foreign body was present. The neck was not injured. Nervous system examination, as far as could be elicited, was normal with no cranial nerve damage or sensory and motor weakness. On auscultation, the breath sounds were normal with no added sounds, suggesting no aspiration of blood into trachea. Rest of the systemic examination was also normal. Chest radiograph was normal and no foreign body was present. He was scheduled to undergo emergency tracheostomy for airway management, debridement, and closure of facial laceration under general anaesthesia.

Anaesthetic management

The patient was shifted to the operating room in the sitting position. We planned for tracheal intubation under sedation using light wand, in anticipation of a difficult airway.
Pulse oximeter, ECG leads, non-invasive blood pressure monitor etc. were connected. Difficult airway cart was kept ready as patient was resuscitated and stabilized vitals (BP 110\84 mm Hg, PR 96\min, SPO2 96%). Injection Propofol 60 mg in sedation doses was administered intravenously slowly to enable the patient to lie supine. Airway was cleared by suctioning and holding forward of the fractured bones. The loose teeth were easily pulled out lest they should get dislodged. After adequate preoxygenation with a mask held close to the face we tried to perform direct laryngoscopy, but to our dismay, the blade could not be maneuvered once it was introduced into the oral cavity. Thereafter, we went for intubation using light wand. The operating room lights were dimmed and a well-lubricated, 8.0 mm endotracheal tube mounted light wand, which had been pre-shaped in the hockey stick manner was inserted in the oral cavity The usual technique of light wand intubation was used and the patient was easily intubated in the first attempt. The correct placement of the endotracheal tube was confirmed by chest auscultation. The entire process took thirty seconds. The tube was fixed securely with the help of a bandage. The anaesthesia was maintained with 40:60 O2: N2O, inj. Vecuronium bromide and halothane. The surgeons proceeded with the tracheostomy. Despite meticulous dissection, they had difficulty in locating the trachea. The light wand was introduced into the endotracheal tube and the transillumination directed the surgeons towards the exact location. As the surgeon was about to incise the trachea, the endotracheal tube cuff was deflated and the light wand was removed. When the trachea was adequately incised, the orally placed endotracheal tube was slowly pulled out and a 7.5 mm ID cuffed tracheostomy tube was inserted. The breathing circuit was connected to the tracheotomy tube. Facial laceration was debrided and closed. The entire surgical procedure took 1.5 hours. Giving reversal reversed the residual effect of neuromuscular blockade. After ensuring an adequate tidal volume and when the patient was following commands patient was shifted in the postoperative room. Oxygen inhalation was continued in the postoperative period. The patient was monitored till 24 hours for any complications. Then patient was referred for a CT scan of head, face, and neck. Three-dimensional CT scan of face showed complex comminuted fracture of face involving bilateral maxilla (anterior, lateral, medial wall, and alveolar process), hard palate, orbital wall, nasal bones, septum, and roof of nose and left sided base of pterygoid plate with opacification of bilateral maxillary, ethmoidal, and sphenoid sinuses. Zygomatic bones, eyeball, and optic nerve were normal. CT scan of head and neck were normal.

He was posted for definitive repair of face three days later when the edema of the bilateral ramus and body of mandible, left coronoid process of mandible face had subsided. The surgical procedure took 3.5 hours. The patient continues to do well waiting for bone grafting and prosthesis implant [Figure 2, this one].

Sources:
http://www.onlinejets.org/text.asp?2009/2/1/51/44685
http://www.ncbi.nlm.nih.gov/pmc/arti...5/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pmc/arti.../figure/F0002/

And the references are these ones:
1. Nayyar P, Lisbon A. Non-operating room emergency airway management and endotracheal intubation practices: A survey of anaesthesiology program directors. Anaesth Analg. 1997;85:62–8.
2. Sarkar MS, Puri V. Faciomaxillary surgery: Our experience, anaesthesiologist's perspective. Int J Anaesthesiol. 2007;12:1.
3. Meyer C, Valfrey J, Kjartansdottir T, Wilk A, Barrière P. Indication for and technical refinements of submental intubation in oral and maxillofacial surgery. J Craniomaxillofac Surg. 2003;31:383–8.
4. Hung OR, Stewart RD. Light wand Intubation: I, A new intubating device. Can J Anaesthesiol. 1995;42:820–5.
5. Addas BM, Howes WJ, Hung OR. Light-guided tracheal puncture for percutaneous tracheostomy. Can J Anaesthesiol. 2000;47:919–22.
6. Saravanan P, Arrowsmith JE. Retrograde submental intubation after faciomaxillary trauma. Anesth Analg. 2005;101:1893–4.
7. Piepho T, Thierbach A, Werner C. Nasotracheal intubation: Look before you leap. Br J Anaesth. 2005;94:859–60.
8. Klafta JM, Olson JP. Emergent lung separation for management of pulmonary artery rupture. Anesthesiology. 1997;87:1248–50.
9. Marlow TJ, Goltra DD, Jr, Schabel SI. Intracranial placement of a nasotracheal tube after facial fracture: A rare complication. J Emerg Med. 1997;15:187–91.

I'd like to point out that the article by Medic Mark is unfair, unprofessional and useless:

Unfair because whenever you pick a photo from some article made by professionals, you MUST mention the original article, for a matter of respect towards the authors and your own readers, but not only

Unprofessional because it sounds like an article written by some plumber after 12 hours of dirthy work under the sun smelling shit (with all the due respect for plumbers)

Useless because photo # 1 makes sense ONLY if accompanied with explanations and photo # 2: otherwise, the WHOLE article would have never had any reason to exist.


Needless to say, i think that some gore lovers did the right thing when they shared the photo

however
leave science alone, especially if you deny to your readers the right to know because you're too lazy to copy&paste the due credits and a link to the explanation.

Mark=Maybe
Medic=Hopefully, not.

[bluepinktriangle]

Originally Posted by Matt_Z ↗

Please don't try to kill yourself. Seek help. "

Sometimes its the only way out, and all of the time its going out the way you choose. Suicide will be my cause of death, Because when im at the lowest in my life and im getting old, I can choose not to be a burden on people by topping myself. Unlike most old decrepit fuckers out there who are just plain fucking selfish. The difference between me and this dude is that i wont be using no dam shotgun.

[☠ Sting ☠]

"If you fail, you must try... Try, try again."

[k_dub]

Motherfuck. Better luck next time

[Rogan]

just imagine, you wanna tell the first person you see to "finish me off" but it comes out as "I hate custard."

anyway, between you and me, as soon as I read the post's subject, ie., "suicide attempt" my heart skipped a beat. The gore monkey on my back knew, I would find some good gore here. And I found it.

This kind of wound reminds me of that poor Syrian kid who got half his face blown off, yall know the picture, even my mom does. He dead, and I'm hoping our guy here he dead too by now. but he aint, and he looks about 3 times worse than he did when things were still normal *dollar bills in his fist, counting* how many betting he'll do it again, 2 weeks, 2 months, 1 year?

sad, sad, fucking world

[Rogan]

Originally Posted by JackiRive26 ↗

I seen this guy before somewhere, thanks for the lovely reunion.

it's not the same guy

[Shylock]

stupid Cunt

[kellyhound]

daamn