Thoughts
a) perform an RSI to secure her airway before anything catastrophic happens
a) This may or may not be easy. The tip of the knife handle is just under the chin and will reduce mouth opening. As she has no immediate airway compromise there is time to ask for anaesthetic help.

b) obtain X rays to get a better idea of potential problems
b) Good idea. Have a look at these.

c) refer to ENT as there is nothing more for you to do
c) Another good idea, but stick around they might want to do something foolish, such as disappearing off to the CT scanner.

d) say, "She is cardiovascularly stable, has a patent airway, therefore she hasn't hit any important structures", and pull the knife out
d) May be not, but …. Two very senior colleagues: a vascular surgeon and a cardiothoracic surgeon, both suggested just pulling it out, IF, after imaging there was no evidence of a vascular injury. Given that she was cardiovascularly stable a significant vascular injury seemed unlikely. Their argument being that a formal exploration would expose her to considerable risk of surgical trauma.

e) get your mobile phone out and take a few pictures for the album
e) Avoid the temptation. This requires informed consent.


In the event the ENT SpR performed a nasendoscopy and established that the airway was clear, although there was a left vocal cord palsy. After discussions with the cardiothoracic and vascular surgeons she was taken to theatre and had an RSI there. She then had on-table angiography which confirmed that there was no obvious vascular injury. Her wound was explored and once the tip of the knife had been visualised it was removed. She was extubated after the operation and sent to the ENT ward. It is not known what happened to the husband, but he was having an interview with the Police the last time we hears, and it did not look as though he would be celebrating New Year this side of a jail cell.