Light hemoptysis or tracheoinnominate fistula?

[VentdependenT]

Teen in the hospital with hx of congenital abnormalities and multiple prolonged intubations, subglottic stenosis, hx of trach (maybe he still had one, not completely sure) blah blah blah, presents for routine DL in the OR. I wasn't in on the case only walked in to sign something out...bad scene.

Anyhoots, some hx of hemoptysis, hence the DL. Blood starts comming slowly during the DL. It gets worse fast. Soon the ENT' dudes couldn't see jack. After trying to locate the bleeder they tried to tamponade the bleed with a cuffed ett. No luck. Chest compressions, blood products, eventually they cut the chest with a CV surgeon to help locate the bleed and stop it. Too late.

Have any of you had experience with this?

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[militarymd]

just ruptured pa arteries...with exanguination into the airway...not like what you described.

 

[jetproppilot]

Teen in the hospital with hx of congenital abnormalities and multiple prolonged intubations, subglottic stenosis, hx of trach (maybe he still had one, not completely sure) blah blah blah, presents for routine DL in the OR. I wasn't in on the case only walked in to sign something out...bad scene.

Anyhoots, some hx of hemoptysis, hence the DL. Blood starts comming slowly during the DL. It gets worse fast. Soon the ENT' dudes couldn't see jack. After trying to locate the bleeder they tried to tamponade the bleed with a cuffed ett. No luck. Chest compressions, blood products, eventually they cut the chest with a CV surgeon to help locate the bleed and stop it. Too late.

Have any of you had experience with this?

No. Thank God no.

 

[urge]

No, and I plan to keep it that way.

 

[Noyac]

Sounds like fun

Only thing I can think of that is similar was back in residency when I was a CA2 starting a heart (one of my first hearts) and my attending left quickly after induction to help out in another room. I didn't see him for about 2hrs (this was residency so we had just cracked the chest). He came back with his eyes as big as saucers. He described the same scenario. Not sure what the final outcome was but it wasn't good.

 

[Benzwiz]

we had a patient with a tracheoinominate fistula while I was doing my internship. s/p trauma with prolonged intubation - trached. The chest surgeon had temporized it with a muscle flap, I think, and she ended up going to Boston or NYC to get it fixed, with good results I believe.
Nobody wanted to touch that patient... scary situation.

 

[Trisomy13]

Vent,
Sounds like a good description of a tracheo-innominate fistula. The history is right (previous trach, anomalies), and the presentation matches - sentinel bleed followed by profuse bleed with poor outcome. I've only seen one, as a med student in a SICU with a pt with a trach. Makes you hypervigilant when you see one.