Someone almost died

[militarymd]

Got called STAT to the PACU.

I run over and saw this lady sitting up right...looking uncomfortable and scared.

There is a dressing on her neck....and an obvious hematoma...about grapefruit size.

On top of this, she is pretty micrognathic.

Vitals stable...SAO2 100%.

What to do...what to do....and what probably not to do........

The nurse told her to take some deep breaths... the patient keeps trying...and fails..

I watched her lose her airway before my eyes...

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[rn29306]

Got called STAT to the PACU.

I run over and saw this lady sitting up right...looking uncomfortable and scared.

There is a dressing on her neck....and an obvious hematoma...about grapefruit size.

On top of this, she is pretty micrognathic.

Vitals stable...SAO2 100%.

What to do...what to do....and what probably not to do........

The nurse told her to take some deep breaths... the patient keeps trying...and fails..

I watched her lose her airway before my eyes...

Cut that damned hematoma right there in PACU. Draining it allows pressure to be relieved, internal pressure on the trachea to be relieved, hopefully spont respirations to resume while an OR is readied for her. Supplemental O2 if not already applied.Yes, it will bleed like a mofo, that's secondary at this point. You can always give blood later. Good thing is that she is already NPO from surgery 5 minutes ago. Have MD or CRNA that initially intubated her on the first surgery there for the 2nd induction - they already have an idea of what to expect seeing how they did the first intubation.

Then reach down and catch that 2 lb brown tater log you just allowed to get out of the sphincter.

Oh yeah, about 5 mgs versed upon induction the 2nd time around. 3mgs for her, 2mgs for me.

 

[militarymd]

Actually, cutting the neck and relieving the hematoma did not relieve the a/w obstruction.

 

[jetproppilot]

Got called STAT to the PACU.

I run over and saw this lady sitting up right...looking uncomfortable and scared.

There is a dressing on her neck....and an obvious hematoma...about grapefruit size.

On top of this, she is pretty micrognathic.

Vitals stable...SAO2 100%.

What to do...what to do....and what probably not to do........

The nurse told her to take some deep breaths... the patient keeps trying...and fails..

I watched her lose her airway before my eyes...

Mil's case and being level at 9000 ft in a single engine airplane at night when your engine fails is basically the same scenerio.

You're f ukked unless you keep your cool, act quickly, and have a plan.

I'll save the engine-out-at-night scenerio for the www.igetmyrocksoffflyingairplanes.com website.

Back to Mil's case.

Agree with RN29847638 that you open the incision right there, right now and hope it ameliorates the anatomical distortion making something recognizeable during laryngoscopy.

Sounds like it didnt.

Heres what I'd do.

I'd still take a look with my favorite blade....for me the Miller 2, with a bougie and a styletted, hockey-pucked tube at my side. I'd concominantly tell someone to run and get the jet ventilator. Maybe I'll get lucky....

This is scary grounds, folks.

Mil's lady is gonna die if he doesnt pull a rabbit out of his asian-party-hat.

That sat-monitor singing the falsetto-note of 100% is gonna quickly change to A gangsta-Escalade's subwoofer if the lady ain't exchangin' air.

Before you take a look, lay her flat, put the ambu on her, and pull up on her mandible like Matt Hughes squeezes a rear naked choke.

Are you getting any air in?

If so, realize this is only an attempt to maximize her FRC to give you more time for subsequent intervention. If she occluded her airway by herself, pulling up on her mandible with concominant positive pressure breaths is a temporary (very temporary) measure at best.

If the stars have ligned up, you'll create a patent-enough airway to allow someone (ENT dude) to get there and do a bedside trach.

If the stars are outta alignment youre able to squeak in some of that FiO2=1.0 air to buy you more time while youre doing what you have to do.

If the situation is the latter, you're up against the fence.

Take your favorite blade and take a look. Hopefully you'll see something recognizeable and be able to get a tube or a bougie through the cords.

OK, youre unsuccessful.

If her sat is still good, take your time with this next step, since identifying the holy-grail-spot is the hard part. And by taking your time I mean thirty seconds.

Identify the cricothyroid membrane.

Then stick it with your choice of ventilatable daggers.....like a 14" angio, or the proprietary cool-trach-thinghy I've got on my car keys.....

....hook up and ventilate away.

This is where we earn our money.

 

[militarymd]

Here's what happened.


I knew that no matter what happened, she was going to have her neck opened....either in a controlled fashion or a uncontrolled fashion.

Her surgeon was unavailable, so I had the PACU nurse page overhead any General Surgeon or ENT STAT to the OR.

Her neck was opened as we were rolling her back to the operating room.

Once we were in the OR, her neck was open, lots of blood all over the place. Everyone who was near her got bloodied.

Despite the open neck, and me with a mask on her face....minimal air going in and out....still has a pulse, but she''s pretty blue.

ENT stud and I agree that I take a look....quick DL...see arytenoids....tube DOES NOT PASS....meeting resistance.

I give the ENT a nod....and he dives into the open wound with scalpel and hemostats.....30 seconds later....tube into trachea.....She pinks up....and the case was essentially done.

 

[militarymd]

1) the fix for this woman was an operation one way or another....timing is variable based on how badly/quickly the hematoma is expanding.

2) As the anesthesiologist, you need to recognize that this is a Dynamic Variable Extra-Thoracic Airway Obstruction

3) Medical therapy for this type of airway obstruction is to DECREASE ventilation. High inspiratory forces will make it WORSE. These patients are agitated and short of breath.......so guess what they do???? They try to breath in HARD....and guess what....that makes it WORSE. Medical therapy is to DECREASE minute ventilation with drugs...ie take away the urge to breath. Telling the patients to take deep breaths IS the WRONG thing to do.....and was exactly what the patient was told right when I arrived......This was followed quickly by airway closure.

4) Get the most skilled person with a knife and get them to the bedside ASAP...if no one is skilled with a knife, then pick up a knife and be prepared to cut.

 

[jetproppilot]

Here's what happened.


I knew that no matter what happened, she was going to have her neck opened....either in a controlled fashion or a uncontrolled fashion.

Her surgeon was unavailable, so I had the PACU nurse page overhead any General Surgeon or ENT STAT to the OR.

Her neck was opened as we were rolling her back to the operating room.

Once we were in the OR, her neck was open, lots of blood all over the place. Everyone who was near her got bloodied.

Despite the open neck, and me with a mask on her face....minimal air going in and out....still has a pulse, but she''s pretty blue.

ENT stud and I agree that I take a look....quick DL...see arytenoids....tube DOES NOT PASS....meeting resistance.

I give the ENT a nod....and he dives into the open wound with scalpel and hemostats.....30 seconds later....tube into trachea.....She pinks up....and the case was essentially done.

Call the CEO of your hospital and tell him you want a 50-thousand-dollar "endowment" by the end of the month for saving his hospital a ton of money.....

....and that if he doesnt give it to you, you're moving to New Orleans to take over the anesthesia world with Jet, UT, and Noyac.

Nice, nice job, Dude.

 

[jetproppilot]

1) the fix for this woman was an operation one way or another....timing is variable based on how badly/quickly the hematoma is expanding.

2) As the anesthesiologist, you need to recognize that this is a Dynamic Variable Extra-Thoracic Airway Obstruction

3) Medical therapy for this type of airway obstruction is to DECREASE ventilation. High inspiratory forces will make it WORSE. These patients are agitated and short of breath.......so guess what they do???? They try to breath in HARD....and guess what....that makes it WORSE. Medical therapy is to DECREASE minute ventilation with drugs...ie take away the urge to breath. Telling the patients to take deep breaths IS the WRONG thing to do.....and was exactly what the patient was told right when I arrived......This was followed quickly by airway closure.

4) Get the most skilled person with a knife and get them to the bedside ASAP...if no one is skilled with a knife, then pick up a knife and be prepared to cut.

And you budding anesthesia-dudes periodically get offended by Mil's bluntess in his posts.

Whenever you post and Mil subsequently challenges you, and you start to feel your feminine side, all vulnerable and offended,

pull up this thread.

And recognize the greatness.

And learn.

 

[cchoukal]

By calling this a dynamic variable extrathoracic airway obstruction, do you mean that as she takes deep inspiration, decreasing intrathoracic pressure, that she'll further collapse her trachea via this further decrease in pressure? Is the trachea really that collapsable? It seems like if this were the case, more ventilation is only bad if SHE is trying to provide it by decreasing intrathoracic (and, thus, intra-tracheal?) pressure, not if you are providing it for her with positive pressure ventilation. Am I thinking about this the right way?

 

[jetproppilot]

Here's what happened.


I knew that no matter what happened, she was going to have her neck opened....either in a controlled fashion or a uncontrolled fashion.

Her surgeon was unavailable, so I had the PACU nurse page overhead any General Surgeon or ENT STAT to the OR.

Her neck was opened as we were rolling her back to the operating room.

Once we were in the OR, her neck was open, lots of blood all over the place. Everyone who was near her got bloodied.

Despite the open neck, and me with a mask on her face....minimal air going in and out....still has a pulse, but she''s pretty blue.

ENT stud and I agree that I take a look....quick DL...see arytenoids....tube DOES NOT PASS....meeting resistance.

I give the ENT a nod....and he dives into the open wound with scalpel and hemostats.....30 seconds later....tube into trachea.....She pinks up....and the case was essentially done.

The only thing I wouldda done different, Mil, is I wouldnt've rolled her anywhere.

I dont think theres alotta benefit in the transition, and during the transition to the OR its impossible to do anything, and its possible things could go south REAL quick during the transition, leaving you in the transition-hallway-phase with nothing except rushing to the OR....all-the-while burning FRC oxygen...

I wouldda stayed put in the PACU. Nurses have to go get stuff to set up the OR you are going to....they can just as easily bring it to the PACU if needed....

all the while affording you the luxury of a non-moving stretcher to stick the neck if you have to.

Doing a trach in the PACU, even by the ENT dude, is really no different than the OR. Too much time in transit/moving patient to OR bed/rehooking up monitors that were already in place in the PACU....

I wouldve nested in the PACU, secured an airway by me or whatever-available-dude, then moved to the OR for touch-ups.

Certainly not a critisicm.

Just how I woullda handled it with a little different twist.

 

[rn29306]

Here's what happened.


I knew that no matter what happened, she was going to have her neck opened....either in a controlled fashion or a uncontrolled fashion.

Her surgeon was unavailable, so I had the PACU nurse page overhead any General Surgeon or ENT STAT to the OR.

Her neck was opened as we were rolling her back to the operating room.

Once we were in the OR, her neck was open, lots of blood all over the place. Everyone who was near her got bloodied.

Despite the open neck, and me with a mask on her face....minimal air going in and out....still has a pulse, but she''s pretty blue.

ENT stud and I agree that I take a look....quick DL...see arytenoids....tube DOES NOT PASS....meeting resistance.

I give the ENT a nod....and he dives into the open wound with scalpel and hemostats.....30 seconds later....tube into trachea.....She pinks up....and the case was essentially done.

Very, very nice.

 

[KluverBucy]

great thread. love to learn about this ****. makes me remember why i actually log onto this site after the issues in the anesthesia forum recently.

 

[militarymd]

The only thing I wouldda done different, Mil, is I wouldnt've rolled her anywhere.

I dont think theres alotta benefit in the transition, and during the transition to the OR its impossible to do anything, and its possible things could go south REAL quick during the transition, leaving you in the transition-hallway-phase with nothing except rushing to the OR....all-the-while burning FRC oxygen...

I wouldda stayed put in the PACU. Nurses have to go get stuff to set up the OR you are going to....they can just as easily bring it to the PACU if needed....

all the while affording you the luxury of a non-moving stretcher to stick the neck if you have to.

Doing a trach in the PACU, even by the ENT dude, is really no different than the OR. Too much time in transit/moving patient to OR bed/rehooking up monitors that were already in place in the PACU....

I wouldve nested in the PACU, secured an airway by me or whatever-available-dude, then moved to the OR for touch-ups.

Certainly not a critisicm.

Just how I woullda handled it with a little different twist.

Yeah, I thought about that.....it was a close call....the deciding factor was the OR in question was the first one outside of the PACU...but you are absolutely right....I definitely thought about staying....

This is one of situation where you can't train for it..

The lady was very lucky that 2 of our very experienced ENT guys were in house and between cases.

 

[militarymd]

By calling this a dynamic variable extrathoracic airway obstruction, do you mean that as she takes deep inspiration, decreasing intrathoracic pressure, that she'll further collapse her trachea via this further decrease in pressure? Is the trachea really that collapsable? It seems like if this were the case, more ventilation is only bad if SHE is trying to provide it by decreasing intrathoracic (and, thus, intra-tracheal?) pressure, not if you are providing it for her with positive pressure ventilation. Am I thinking about this the right way?

In this case, her effects made the a/w more narrow. Between the bleeding and swelling, there was no a/w even after opening the neck.

In this type of a/w obstruction, spontaneous resp makes things worse,but positive pressure by mask does not.

 

[dogbone65]

BRAVO ZULU

 

[supahfresh]

nice save!!!

so what was her original surgery?

why don't they let us do trachs during residency?

 

[Gator05]

Do you really NEED to pass a tube this emergently?

She's not going to die of hypercarbia. Rather, all we want is to get oxygen in.

If there was a Cook catheter present, and you can see anything, why not push in a Cook and hook it up to an O2 source? Apneic oxygen isn't pretty, but it works.

For that matter, what about (lots of) CPAP? After all, this could have been up on the "floor", far and away from anything sharp...

 

[sevoflurane]

why don't they let us do trachs during residency?

Good question. Scary case, but a great one to think through with the retroscope.

 

[bigdan]

great thread. love to learn about this ****. makes me remember why i actually log onto this site after the issues in the anesthesia forum recently.

Ditto. And thanks for not posting it in the Country Club, where I am not a member.

Keep it coming!

dc

 

[cchoukal]

nice save!!!

so what was her original surgery?

why don't they let us do trachs during residency?

Some programs do. University of Chicago and, I believe, Medical Univ of South Carolina do a month on ENT to do trachs and practice fiberoptic exams.

 

[VentdependenT]

Damn Mil....

 

[rn29306]

Here's what happened.


I knew that no matter what happened, she was going to have her neck opened....either in a controlled fashion or a uncontrolled fashion.

Her surgeon was unavailable, so I had the PACU nurse page overhead any General Surgeon or ENT STAT to the OR.

Her neck was opened as we were rolling her back to the operating room.

Once we were in the OR, her neck was open, lots of blood all over the place. Everyone who was near her got bloodied.

Despite the open neck, and me with a mask on her face....minimal air going in and out....still has a pulse, but she''s pretty blue.

ENT stud and I agree that I take a look....quick DL...see arytenoids....tube DOES NOT PASS....meeting resistance.

I give the ENT a nod....and he dives into the open wound with scalpel and hemostats.....30 seconds later....tube into trachea.....She pinks up....and the case was essentially done.

At any point in time did someone in the room besides you even get a chance to get some form of medicine on-board this lady (ie versed or just stun dose of propofol). Did you to a DL on an awake person or had hypoxia pretty much taken care of that for you? I realize this is ENTIRELY secondary to her getting her life saved, but I wonder it she'll try to sue.

 

[militarymd]

At any point in time did someone in the room besides you even get a chance to get some form of medicine on-board this lady (ie versed or just stun dose of propofol). Did you to a DL on an awake person or had hypoxia pretty much taken care of that for you? I realize this is ENTIRELY secondary to her getting her life saved, but I wonder it she'll try to sue.

I wasn't sure if she was awake or not, but she was cyanotic....I frequently DL awake patients...ICU experience.

She was obstructed enough that she didn't care...and she doesn't remember. I asked her.

She had a thyroidectomy.

 

[Sammich81]

1) the fix for this woman was an operation one way or another....timing is variable based on how badly/quickly the hematoma is expanding.

2) As the anesthesiologist, you need to recognize that this is a Dynamic Variable Extra-Thoracic Airway Obstruction

3) Medical therapy for this type of airway obstruction is to DECREASE ventilation. High inspiratory forces will make it WORSE. These patients are agitated and short of breath.......so guess what they do???? They try to breath in HARD....and guess what....that makes it WORSE. Medical therapy is to DECREASE minute ventilation with drugs...ie take away the urge to breath. Telling the patients to take deep breaths IS the WRONG thing to do.....and was exactly what the patient was told right when I arrived......This was followed quickly by airway closure.

4) Get the most skilled person with a knife and get them to the bedside ASAP...if no one is skilled with a knife, then pick up a knife and be prepared to cut.

Just reading this case got my heart all a-flutter. I think I might have peed my pants a little if I were there.

Just to clarify--rn kind of already aksed this question--but is the fact that it is a dynamic extrathoracic obstruction what makes inspiratory efforts worse? What if it were airway swelling? Would that also be exacerbated by inspiration?

Also why do you suppose draining the hematoma didn't help like it should? It was the source of obstruction...once it's gone what is making your life hell? Does the airway get swollen after compression/irritation?

And finally, how did you do a DL so fast? I rotated on ENT and that stuff takes awhile to set up.

 

[rn29306]

And finally, how did you do a DL so fast? I rotated on ENT and that stuff takes awhile to set up.

A STAT overhead page in the OR brings people out of the woodwork. Funny how people STAT this and STAT that on the floors and all, but say it in the OR and people know you ain't ****tin around.

I bet there was an ENT, a scapel in righty, hemostat in lefty, and maybe some bedtadine for good measure.

 

[militarymd]

Just reading this case got my heart all a-flutter. I think I might have peed my pants a little if I were there.

I think I did peed my pants

Just to clarify--rn kind of already aksed this question--but is the fact that it is a dynamic extrathoracic obstruction what makes inspiratory efforts worse? What if it were airway swelling? Would that also be exacerbated by inspiration?

You can look this one up....venturi effect

Also why do you suppose draining the hematoma didn't help like it should? It was the source of obstruction...once it's gone what is making your life hell? Does the airway get swollen after compression/irritation?

I don't know...probably edema

And finally, how did you do a DL so fast? I rotated on ENT and that stuff takes awhile to set up.

uhh???

 

[VentdependenT]

Dl = Direct Laryngoscopy

 

[Sammich81]

A STAT overhead page in the OR brings people out of the woodwork. Funny how people STAT this and STAT that on the floors and all, but say it in the OR and people know you ain't ****tin around.

I bet there was an ENT, a scapel in righty, hemostat in lefty, and maybe some bedtadine for good measure.

Hey, STAT means something? I am languishing away on internal medicine right now, and the only way I get STAT labs are if I or my resident calls up and harasses the nurse/phlebotomist and explains how this is going to determine immediate management. Medicine is so interesting intellectually and so incredibly slowwwwwww in reality.

 

[jetproppilot]

And finally, how did you do a DL so fast? I rotated on ENT and that stuff takes awhile to set up.

Mil is referring to taking a look with a laryngyscope.

 

[Sammich81]

I think I did peed my pants



You can look this one up....venturi effect

Venturi effect special case of Bernoulli's. sweet Lord has physics 231 junior year of college come back to haunt me?

 

[drRumi]

mil, how much of this knowledge and comfort of dealing with situations like this comes from your anes. residency vs. your CC fellowship? how comfortable do you think you would be in a situation like this if you hadnt done a CC fellowship? im assuming that having done a CC fellowhip is gotta give one the confidence and balls to be able to stare death in the face yet still manage to think fast enough to save the dude.

 

[VentdependenT]

Venturi effect special case of Bernoulli's. sweet Lord has physics 231 junior year of college come back to haunt me?

Its back for IHSS/HOCM. Venturi makes me think of that old k-mart like store: Venture. It was white with diagonal thick black stripes. Ohhhhh man, my circuits are fried.

 

[militarymd]

mil, how much of this knowledge and comfort of dealing with situations like this comes from your anes. residency vs. your CC fellowship? how comfortable do you think you would be in a situation like this if you hadnt done a CC fellowship? im assuming that having done a CC fellowhip is gotta give one the confidence and balls to be able to stare death in the face yet still manage to think fast enough to save the dude.

Let me say it again...I didn't save the patient...the experiecned ENT who did the trach in 30 seconds flat did.

As for staying calm when there is brown stuff and red stuff flying around.....I think some people have it and some people don't....there was a thread on this a while back.

I would like to think that I'm one of the ones who know how to use the force...the fellowship had nothing to do with it.

 

[jetproppilot]

Let me say it again...I didn't save the patient...the experiecned ENT who did the trach in 30 seconds flat did.

As for staying calm when there is brown stuff and red stuff flying around.....I think some people have it and some people don't....there was a thread on this a while back.

I would like to think that I'm one of the ones who know how to use the force...the fellowship had nothing to do with it.

THE FORCE.

Fuk ki n A.

You.ve either got it or you dont.

But I disagree with you.

You are the one that evaluated the patient and knew what had to be done....and the time constraints involved. You didnt waste time where many would have.

You ACTED.

The thyroid lady owes YOU and the ENT dude a bottle of Caymus Cabernet, 2003 vintage.

 

[Sammich81]

Let me say it again...I didn't save the patient...the experiecned ENT who did the trach in 30 seconds flat did.

As for staying calm when there is brown stuff and red stuff flying around.....I think some people have it and some people don't....there was a thread on this a while back.

I would like to think that I'm one of the ones who know how to use the force...the fellowship had nothing to do with it.

Any way to tell if you've got it before you're actually covered in the red and brown stuff?

And what is IHSS/HOCM (from VentDependent's last post)?

 

[jetproppilot]

Any way to tell if you've got it before you're actually covered in the red and brown stuff?

And what is IHSS/HOCM (from VentDependent's last post)?

ideopathic hypertrophic subaortic stenosis.

my brain hurts from writing that.

He's relaying his dissent with reading about some boring s h it.

 

[supahfresh]

Dl = Direct Laryngoscopy

vent is from the hood where DL really means down-low. for example: Hey I got some rocks and some tex-mex stashed in my pocket but keep that on the DL.

 

[Sammich81]

ideopathic hypertrophic subaortic stenosis.

my brain hurts from writing that.

.

It's all the time up way up high w/low oxygen. One of my best friends is a pilot/flight instructor at Auburn and I swear he gets crazier the more he flies

 

[CanGas]

Also why do you suppose draining the hematoma didn't help like it should? It was the source of obstruction...once it's gone what is making your life hell? Does the airway get swollen after compression/irritation?

Tried to find some references but could not and am too post-call to care. So this is anecdotal.

I have been told by ENT that in many situations of neck hematoma post thyroid/CEA/neck disection/ect, don't expect simply opening the neck to relieve the obstruction. It can't hurt but the problem is mostly 2nd to arterial bleeding not venous which instead of having a nice confined hematoma that can be scooped out when the skin is opened, it drives blood along the tissue planes in the neck to form a mass of edematous tissue and clot.

You also asked how the trach could go so fast. 1 - the guy was good. 2 - there is already a nicely disected out trachea from the thyroidectomy so that in general you just have to open the skin sutures, and the trachea is right there ready to be cut and tubed.

Good save Mil.

 

[Danger Man]

What type of procedure did she have?

 

[Noyac]

Yes, nice case.
I had a similiar case a few years back. I won't go into all the details but I will make one other point here. My case was a CEA about 4hrs old. We rushed back to the OR for hematoma evac. and the pt was breathing fine on his own and speaking. I asked the surgeon if he could do this under local since the airway was patent and the guy was LARGE with no neck. As we pulled the drapes off after the evac. the guy stops breathing. I was on call and it was late in the evening so I had a crna in the case after the evac. since I had other cases going. I get called back STAT. Crna can't tube him and the pt is blue. I take a look and can't see anything but blood and swollen tissue. I have crna push on chest and a bubble comes up out of the trachea. Wam, I stuff the ETT there and start bagging. It was in the trachea and all was well. The bottom line is that when these cases come bto you, just remember that the edema can cause the airway to be lost even after the hematoma is evacuated.
My current technique is: evac under local and then once the clot is out, tube the pt. Then let the surgeon fix the bleeder.

 

[adleyinga]

Got called STAT to the PACU.

I run over and saw this lady sitting up right...looking uncomfortable and scared.

There is a dressing on her neck....and an obvious hematoma...about grapefruit size.

On top of this, she is pretty micrognathic.

Vitals stable...SAO2 100%.

What to do...what to do....and what probably not to do........

The nurse told her to take some deep breaths... the patient keeps trying...and fails..

I watched her lose her airway before my eyes...

This case reminds me of a similar one I had recently
Some idiot will cleaning his shot gun -shot himself with birdshot in the neck. Airway is swelling, neck is swelling.

Trauma surgeons brings pt immediately to OR for stat trach.

Surgeon afraid can't peform trach because so much swelling. While we move him to OR table turns blue, getting hypoxic, pulse ox is yelling at us and surgeon is ****ting in his pants because neck is now 6 inches of bloody swollen tissue.

Well I held my tounge to the left, held my sphincter real tight and did laryngoscopy with Miller 3. Lucked in a bougie through the center of the MIller - don't know how- saw almost nothing - and slid a tube in.

Case cancelled- never came back- swelling got better and the jerk went home with bird shot in his neck.

Better lucky than good

 

[jetproppilot]

Got called STAT to the PACU.

I run over and saw this lady sitting up right...looking uncomfortable and scared.

There is a dressing on her neck....and an obvious hematoma...about grapefruit size.

On top of this, she is pretty micrognathic.

Vitals stable...SAO2 100%.

What to do...what to do....and what probably not to do........

The nurse told her to take some deep breaths... the patient keeps trying...and fails..

I watched her lose her airway before my eyes...

whoa