Importance of perioperative planning in an impalement injury of neck highlighted by an aberrant right subclavian artery

[Extract] An otherwise well 42-year-old male presented to the emergencydepartment by ambulance with an impalement injury to the rightside of the neck by a 5-cm diameter and 27-cm length tree branchfollowing a motor bike accident. Physical examination on arrivalrevealed a Glasgow Coma Scale of 15, peripheral capillary oxygensaturation 96% on room air, blood pressure 110/70 mmHg andheart rate of 110 sinus rhythm. Besides an evident anhidrosis on theright side of his face, there were no obvious signs of neurovascularcompromise.