Novel Use of the MADgic Atomiser for Emergency Airway Management in Complex Neck Trauma: A Case Report

Penetrating neck injuries present as a formidable challenge to anaesthesiologists and the trauma care team due to the risk of rapid airway compromise, exsanguination and involvement of multiple vital structures. Securing the airway remains the top priority, especially in patients presenting with neck injuries, active bleeding, tissue disruption, and altered sensorium. Safest methods to secure the airway is in an awake and spontaneously breathing patient. We report a case of a 55-year-old male who presented with a deep anterior neck laceration in hypovolaemic shock in an emergency, in whom a conventional airway was deemed impossible. Then, as a game-changer, the MADgic Atomiser, a mucosal atomiser, was used to facilitate topical anaesthesia in airway management. The traumatic airway being complex, airway management in such a scenario is extremely difficult. Multidisciplinary teamwork remains the gold standard. Here, in this case, oxygenation was utmost important, looking at the blood loss and Glagow Coma Scale (GCS) of the patient. Hence, direct placement of a tracheostomy tube through the exposed tracheal lumen was initiated, followed by definitive oral endotracheal intubation using a C-MAC for further management. This case highlights the novel use of MADgic Atomiser, an innovative airway adjunct, C-MAC, and the critical role of adaptability, along with multidisciplinary teamwork in managing life-threatening neck injuries.