Crazy airway case

Started by olaf
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olaf

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Alright. Been a long time since I've checked this out but I'll try to post some fun cases. You get a call to the ed and there is a couple in a tangle on the stretcher. They had dinner and went home for a nitecap. The tangle involves his prince Albert piercing hooked into her tonsil. Ent dude can't do anything cause she is freaking out. Whatcha wanna do?
 
olaf said:
Alright. Been a long time since I've checked this out but I'll try to post some fun cases. You get a call to the ed and there is a couple in a tangle on the stretcher. They had dinner and went home for a nitecap. The tangle involves his prince Albert piercing hooked into her tonsil. Ent dude can't do anything cause she is freaking out. Whatcha wanna do?
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umm so his penis bling is caught on her tonsil? damn if this is real its a great story in the making...
i am going to think about this scenario, academically of course
 
olaf said:
Alright. Been a long time since I've checked this out but I'll try to post some fun cases. You get a call to the ed and there is a couple in a tangle on the stretcher. They had dinner and went home for a nitecap. The tangle involves his prince Albert piercing hooked into her tonsil. Ent dude can't do anything cause she is freaking out. Whatcha wanna do?
Click to expand...

I hope you have since prank called the ED and asked, "Do you have prince Albert in a can?"
 
olaf said:
Alright. Been a long time since I've checked this out but I'll try to post some fun cases. You get a call to the ed and there is a couple in a tangle on the stretcher. They had dinner and went home for a nitecap. The tangle involves his prince Albert piercing hooked into her tonsil. Ent dude can't do anything cause she is freaking out. Whatcha wanna do?
Click to expand...

Well .... you could rule out elective surgery for the next 6-8 hours, as the female patient isn't NPO.
 
I'll bite:

You're going to need to anesthetize both, right? Call for help.

How freaked out are they? Can they be talked down and redirected?

yes? Do so, IVs, monitors, awake nasal fiber for her (he's not Johnny Wad, right, so there's some room?)

No? Ketamine dart for her, IVs, glidescope attempt (maintaining spontaneous ventilation in the K-hole). Total spinal and a urology consult for penectomy for him.
 
Y'all are amazing! Still get a smile when I think about supra pubic jet ventilation. Had no idea it was actually in a movie tho. Just something funny to bring up at the bar when hanging with colleagues. Nice work!
 
Just spray them with the water hose like you do when dogs get stuck together. I wonder if the ent will do a t and a after all this is said and done. Sounds like a pretty good indication to me.
 
Pigs have rings through the nose to stop them rooting about.

Bulls have rings through the nose so that they can be led by them.

Ladies, if a man has a ring through his junk, think pig not bull.
 
Maybe first they could do a penectomy on the guy, airway with a rapid sequence. Leave the girl alone for now.

So now that they are separated at long last again.

Then, they can do a tonsellectomy on the girl. They can secure the airway with an awake nasal fiberoptic. By waiting some time with the first operation, maybe she isn't a full stomach anymore depending on if you consider sperm a full stomach.

Lastly, they can then reverse the penectomy.

Is this how it all went about. This guy isn't named John Wayne Bobbit by any chance?
 
Penile block for the guy.

Pent sux tube for the girl.

Page urology to fix his wiener.
 
The major thing here is to get the piercing out of the tonsil. You can't do that because the girl is freaking out and won't let ENT near her. So the girl needs to go to sleep.

I know this sounds weird, but is there any possibility of doing an intubation with imaging guidance? Given that there is a groin in her mouth, having a direct view of the cords is a very unlikely thing. But you want her to be sleepy so that ENT can unhook the piercing in the OR, and you want the airway secured so she doesn't aspirate and so if the carotid was hit by the piercing and removing it causes a bloodbath, she's well secured for the repair procedure.

If all else fails, I'd trach her.

I would never consider taking the guy's dick off. That's unneccessary.
 
I can't really say that I know exactly how I would handle this but one thing that comes to my mind in jet ventilation if you can't do anything else cuz the girl freaks when you get close to her. How to arrange the Jet Ventilation is tricky tho. If you have good access to her neck then think about doing a transtracheal injection except insert an 18-14g jelco catheter. If she still wont let you near her, then somehow you are going to have to calm her down. If I felt confident that I could get in her tracheal then I may induce and go. I understand the risks of aspiration but in the ABC's of resusitation A doesn't stand for aspiration. It stands for Airway. Airway first everyone.
 
pgg said:
If he is then you can threaten stat treatment for priapism. Show him a needle and explain it's going into his corpora cavernosa, that ought to motivate him to limp up (down).
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Maybe detumescence will dislodge the Prince Albert. Maybe that's all this case needs.
 
pgg said:
If he is then you can threaten stat treatment for priapism. Show him a needle and explain it's going into his corpora cavernosa, that ought to motivate him to limp up (down).
Click to expand...

There is another way to achieve detumescence. One of our drugs is notoriously capable of this. Any ideas which one?
 
Noyac said:
There is another way to achieve detumescence. One of our drugs is notoriously capable of this. Any ideas which one?
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This will work so much faster than pharmaceuticals:

JanetReno.jpg
 
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