Bullet, Blood and Airway – Gun Shot Wound Face Managed with Limited Resources

Airway management of patients with gunshot wound (GSW) face with maxillo-facial trauma is complex, critical and requires grit of attending anesthesiologist to ensure patient’s survival. Airway management, ATLS and fluid management are challenging and a defining element in such cases.  Failure to secure the airway and resuscitating can drastically increase the mortality of the patient within few minutes. Here, we report a case of a middle aged soldier  who sustained GSW - with comminuted mandibular fracture , sagittal plain maxillary fracture, posterior pharyngeal wall rupture, nasal bone fracture, frontal bone fracture with active bleeding from mouth and nose who was received in a peripheral military hospital with limited resources and a single anesthesiologist. Our emergency team successfully secured his airway after initial resuscitation, aided in emergency surgery done by maxillo-facial surgeon and also airlifted the patient to tertiary care centre for further management.