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- May 4, 2006
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I have a question I need help with. I am an internist that runs the code team at night when I work. The other night I was called to a code. The patient was 87 and had Parkinson's disease and dementia. She had a PEG and hadn't eaten in years, also she was non-verbal. Let's say her jaw didn't see any use. I never got a straight answer as to why her jaw was frozen one inch open.
I could get the scope in, but her head was stuck in flexion, so there was no chance of extending her neck. Her teeth were all broken and sharp so I was ripping open my fingers trying to force her jaw open. Several people tried, but this was apparently a problem before the code. I even hit her with pancuronium to see if we could loosen it up. Nope. There was zero chance of seeing the cords. I tried blind insertion and probably because of her permanent shoulder and neck flexion, it went nowhere (it was 7.0). I tried the 4.0 LMA...and it didn't even fit between her teeth. We had to bag her during the code. She stayed in asystole for 35 minutes, so we called it.
So, my question, short of cricothyroidotomy, what were my options? Those are the only two pieces of equipment this small hospital carries. Are there any nasal tubes you have had success with? The hospital might be persuaded to purchase a third line option for these kind of cases.
And before someone asks, no it wasn't rigor mortis, it was a witnessed arrest.
I could get the scope in, but her head was stuck in flexion, so there was no chance of extending her neck. Her teeth were all broken and sharp so I was ripping open my fingers trying to force her jaw open. Several people tried, but this was apparently a problem before the code. I even hit her with pancuronium to see if we could loosen it up. Nope. There was zero chance of seeing the cords. I tried blind insertion and probably because of her permanent shoulder and neck flexion, it went nowhere (it was 7.0). I tried the 4.0 LMA...and it didn't even fit between her teeth. We had to bag her during the code. She stayed in asystole for 35 minutes, so we called it.
So, my question, short of cricothyroidotomy, what were my options? Those are the only two pieces of equipment this small hospital carries. Are there any nasal tubes you have had success with? The hospital might be persuaded to purchase a third line option for these kind of cases.
And before someone asks, no it wasn't rigor mortis, it was a witnessed arrest.