case_images: PMC9767719_01
case_images: Above view (a) and side view (b) of the patient lying face down with a toy car wheel on an axle impaled on the lower lumbar region.
case_images: CRIA2022-3753415.001.jpg
case_images: PMC9767719_01_CRIA2022-3753415.001.jpg
case_images: fig1
case_images: A 7-year-old male was transferred urgently to our emergency department with a penetrating injury to the back (Figure 1).
case_images: Radiographic imaging of the patient shows a radiopaque metallic rod and wheel seen at the right hemiabdomen immediately lateral to the L5 vertebrae with no apparent bone involvement at the time of the exam.
case_images: CRIA2022-3753415.002.jpg
case_images: PMC9767719_01_CRIA2022-3753415.002.jpg
case_images: fig2
case_images: He had been impaled by a steel shaft axle connected to a toy wheel, which pierced his lower back just lateral to his lumbosacral spine and entered his abdominal cavity (Figure 2).
case_images: Preoxygenation is followed by a modified rapid-sequence induction using a one-handed technique.
case_images: CRIA2022-3753415.003.jpg
case_images: PMC9767719_01_CRIA2022-3753415.003.jpg
case_images: fig3
case_images: After applying standard monitors, the patient was preoxygenated using a one-handed technique for three minutes (Figure 3).
case_images: Laryngoscopy is performed from the side of the patient.
case_images: CRIA2022-3753415.004.jpg
case_images: PMC9767719_01_CRIA2022-3753415.004.jpg
case_images: fig4
case_images: Tuttlingen, Germany) video laryngoscope with a Macintosh size 4 blade was performed from the right side of the patient (Figure 4). The only other available blades were a Miller 1 and a D-Blade, and given that the Macintosh size 4 blade was too big for the child, the laryngoscope blade was only partially introduced.
case_images: Image depicted is a near representation of the technique used on the second attempt to intubate the patient.
case_images: CRIA2022-3753415.005.jpg
case_images: PMC9767719_01_CRIA2022-3753415.005.jpg
case_images: fig5
case_images: Because of a restricted view of the glottis, a second attempt was made after mask ventilation, this time with the child's head slightly tilted to the right by an assistant and the primary anesthesiologist facing the patient (Figure 5).