Difficult Airway Problems

[EMRaiden]

We had this 18 year old recruit who decided that he didn't like the Army (apparently they yelled at him alot). So one afternoon he comes back from a talk with his sergeant (who yelled at him), and ran into the bathroom. A few minutes later when he didn't come out his buddies broke in an found him curled up on the floor with an 8 1/2" long #2 American Eagle pencil shoved up his right nare to the eraser....

On CT it actually went through the cribiform plate and the midbrain. We decided to tube him for obvious reasons, but had to hold his head really, really still.... Later they pulled the pencil out with a pair of vise-grips and he walked out of the hospital a week later.

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[Mike59]

Originally posted by EMRaiden
We had this 18 year old recruit who decided that he didn't like the Army (apparently they yelled at him alot). So one afternoon he comes back from a talk with his sergeant (who yelled at him), and ran into the bathroom. A few minutes later when he didn't come out his buddies broke in an found him curled up on the floor with an 8 1/2" long #2 American Eagle pencil shoved up his right nare to the eraser....

On CT it actually went through the cribiform plate and the midbrain. We decided to tube him for obvious reasons, but had to hold his head really, really still.... Later they pulled the pencil out with a pair of vise-grips and he walked out of the hospital a week later.

Yikes!

Sorry if they are annoying, but I had a few questions:
What neurlogical deficits were evident on his arrival to the ED? (was he unconscious)?

And how did the pencil actually enter the midbrain, wouldn't it have to pentrate the sphenoid bone to reach back there?

What parts of the rehabilitation process would require a week long in-patient recovery period (as opposed to a shorter stay)?

Thanks in advance!

 

[EMRaiden]

What neurlogical deficits were evident on his arrival to the ED? (was he unconscious)?

He was conscious but moving pretty slowly... and had left sided weakness.

And how did the pencil actually enter the midbrain, wouldn't it have to pentrate the sphenoid bone to reach back there?

You are correct, I mis-spoke, the pencil penetrated the spheniod (Gross was a long time ago) and entered the cranial vault.

What parts of the rehabilitation process would require a week long in-patient recovery period (as opposed to a shorter stay)?

I think the longest part of his stay was vent weaning. There was a great deal of concern that his respiratory centers had been knocked out.

 

[docB]

I swear I am not making this up. Last Fall a nursing home sent me an 85 year old, psychotic, septic, obtunded, aphasic dwarf who needed to be intubated. I thought that was going to be a disaster but it was actually pretty easy. Better lucky than good.

 

[droliver]

While were telling dwarf airway stories.....

I was a junior surgery resident @ McDonald's across the street from the hospital when I got a call from one of the ICU nurses I knew who said "I think there's someone you need to crich, can you come?". I arrived to find two anesthesia attendings bagging this fat dwarf after multiple intubation attempts who was seizing. I come to find out that he was 3 days post op from a cervical fusion for that degenerative dz. that dwarfs get & his neck could be hyperextened. I took one look at him & thought to myself "If I try to crich him, he's going to die". I took him straight to an operating room (at a private hospital mind you) & grabbed a visiting Mexican Laparoscopic fellow who was watching some bariatric surgeries in another room and did an emergent tracheostomy. Two of the ENT residents were around and helped retract so we could see anything, & with three people tractioning the hell of his neck we could see the TOP of his first cricoid ring. We were able to do a real high trach/crich with sats in his 80's being bagged. He ended up doing well from all this and went home decanulated in about 6 days.

 

[docB]

Pretty scary. One of the older EPs at a place I used to moonlight told me about a guy that had tried to hang himself and wound up in a halo. He told the psych guys the right things and was let out. He went to a friend's house and shot himself in the face. So here comes this dude into the ER with a halo and a facial GSW. That guy didn't do well. He wasn't a dwarf though.