Ugly Airway Case

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So I get called to this code in the ICU. No big deal. I walk in and WHOA! The pt is a guy who had some massive neck surgery by ENT earlier in the day. His neck is hugely swollen and ecchymotic with various penrose drains poking out here and there. The critical care doc is doing CPR. The RT is bagging. The ENT is bare handed and has cut the pt's neck from ear to ear and is up to his wrists trying to cric the guy. There's blood everywhere. I get to the head of the bed and try to tube the guy. Nothing. There all this edematous, redundant tissue and I can't see jack. Mac, miller, BURP, bougie, nothing. The good thing is that we were always able to bag him back up. After about 35 minutes of bagging and cutting the ENT got the trach. By the end of it my hands were numb but the pt did well. What a mess.

Did he self extubate or something? It would seem like the ENTs would have been able to predict that his airway would be high risk post surgery and a prophylactic tube left in from the OR.

1) if you can bag then i would suspect a fiberoptic would be another modality
2) thoracic surgery at the bedside to do a median sternotomy and place a distal tube....

Originally Posted by Seaglass

Did he self extubate or something? It would seem like the ENTs would have been able to predict that his airway would be high risk post surgery and a prophylactic tube left in from the OR.

No, they didn't leave him tubed. By the end of it they wished they had.

this is the third case i have heard like this. The first two were in a lecture on bad airway.. Two of the cases were ENT cases that weren't left tubed and when they crashed, had to have messy crich's because of it.