SC High School football player dies during ACL repair

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Probably airway. Young football players can be suprising. But who knows . Second guess would be anaphylaxis.
 
T-burglar said:
Probably airway. Young football players can be suprising. But who knows . Second guess would be anaphylaxis.
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Surprising in terms of what? I’m having trouble envisioning a can’t intubate/can’t ventilate/can’t secure any kind of emergent airway in an otherwise healthy normal appearing teenager.
 
Of course the "healthy" person may have cardiac issues or different electrophysiology of an elite athlete. I once did anesthesia for a UK starting basketball player for a knee arthroscopy and had massive BP and arrhythmia problems throughout the entire anesthetic. Would not have guessed it with a pre-op ECG that was completely normal.
 
Tragic, several possibilities.
Possibly unidentified HOCM, maybe mismanaged hypotension. Maybe done in a surgery center not equipped to best handle this complication.
Possibly MH
Hard to say but boy this is sad.
 
Maybe massive aspiration if LMA was used? Maybe fat embolism? Could be surgical. Maybe they hit the popliteal artery and didn’t realize or have blood products? We need more information.
 
btbam said:
Surprising in terms of what? I’m having trouble envisioning a can’t intubate/can’t ventilate/can’t secure any kind of emergent airway in an otherwise healthy normal appearing teenager.
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There’s a wide range of competence in airway management and I do think that young big muscular men can be surprisingly poor laryngoscopic views. I envision vomit on induction with difficult laryngoscopy piled on top and panic and forgetting to give roc after sux so **** just spirals out of control and nobody can intervene effectively.

Very unlikely a congenital heart defect. Even the rarest **** like HOCM with an actual irritable myocardium or an ALCAPA masquerading as exercise induced asthma would probably get through a plain outpatient surrgery undetected.
 
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algosdoc said:
Of course the "healthy" person may have cardiac issues or different electrophysiology of an elite athlete. I once did anesthesia for a UK starting basketball player for a knee arthroscopy and had massive BP and arrhythmia problems throughout the entire anesthetic. Would not have guessed it with a pre-op ECG that was completely normal.
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Why would you even have a preop EKG?
 
VA Hopeful Dr said:
Just had a meeting, malignant hyperthermia.
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that would've been the most likely cause IMHO. Even something like catastrophic aspiration likely wouldn't cause death quickly, more just a massive hypoxic injury that would evolve over time in the ICU leading to brain death. MH can kill quickly even if correctly recognized and treated. It's rare, but it can happen.
 
MirrorTodd said:
That's interesting. Must've done a general rather than a block with some prop sedation.
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well it would certainly be case report worthy if he didn't have GA. I mean you could have some molecules of sevo floating around the room from a previous case but most places probably do GA for an ACL on a teenager.
 
We do general for our teenage ACLs, but that's mostly cause we have a ****ty surgeon who does them.
 
Just went to review the MHapp on my iPhone. Doesn't work. Apparently not compatible with current iPhone Operating System.

Get it together MHAUS. Some of us actually expect it to be there.
 
How often do you all see MH on average out in practice? For me it averages out over my career to once every 4-5 years.
 
Yeah once in half a decade seems right. I’ve never personally been witness to a supposedly legitimate case in 7 years
 
Seen lots of patients who had known history or reason to suspect MH susceptible. ZERO cases of actual MH. Several colleagues in my practice haven't been as lucky. Thirty years
 
On an 18 year old high schooler, probably no pre-op ECG. On an elite starting basketball player on the number one team in the nation, you will definitely have a pre-op ECG.
 
Hmmm, now I’m wondering if I’m just really unlucky, or if there is some sort of documented regional difference in prevalence of MH.
I’ve also spent most of my career supervising 3-4 rooms, and tended to work a lot over the years. So my chances of seeing it have been higher than many I’d guess.
 
Man o War said:
Hmmm, now I’m wondering if I’m just really unlucky, or if there is some sort of documented regional difference in prevalence of MH.
I’ve also spent most of my career supervising 3-4 rooms, and tended to work a lot over the years. So my chances of seeing it have been higher than many I’d guess.
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Most of my peds attendings who were nearing retirement said they had seen it once or twice in 30 years. Many who've been out of practice 10-15 still haven't seen it. I think once every 4 to 5 years seems a little high, maybe just unlucky.
 
T-burglar said:
There’s a wide range of competence in airway management and I do think that young big muscular men can be surprisingly poor laryngoscopic views. I envision vomit on induction with difficult laryngoscopy piled on top and panic and forgetting to give roc after sux so **** just spirals out of control and nobody can intervene effectively.

V
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No freakin way,,, that did not happen with LMAs glidescopes cmacs, helping hands. Crics,,, very few lost airways nowadays

Perhaps MH.
 
Man o War said:
Hmmm, now I’m wondering if I’m just really unlucky, or if there is some sort of documented regional difference in prevalence of MH.
I’ve also spent most of my career supervising 3-4 rooms, and tended to work a lot over the years. So my chances of seeing it have been higher than many I’d guess.
Click to expand...
Its higher in lumbee indians who live in the lumberton fayettevilel nc area..
 
We had 2 cases in the same month in residency. One that I personally got to witness:

20-something male Tier 1 trauma straight to OR for multiple GSW’s to the abdomen. I guess when it’s your time - it’s your time.
 
If you believe the literature there is very much a regional variation. Myself I have never seen a case in 20 years. One of my partners had a case a few years ago when he redosed sux. That said I hate sux and I do all I can to try to talk people out of using it. Seriously, I go years without using it.
 
Crabbygas said:
If you believe the literature there is very much a regional variation. Myself I have never seen a case in 20 years. One of my partners had a case a few years ago when he redosed sux. That said I hate sux and I do all I can to try to talk people out of using it. Seriously, I go years without using it.
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Don't worry, the rest of us are picking up your slack.
 
Hawaiian Bruin said:
I had 2 cases in 2 years, none before or since.

One was a hip, one was a heart, where it reared its head on pump. I really should write that case up, but I don't feel like it.
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I remember I offered to write up that one coming off CPB. The offer still stands.
 
Hawaiian Bruin said:
If I had got the patient's permission, maybe I would, but didn't. Oh well. That case was a real doozy.
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I read the thread at the gym at like 4 am my time. I still remember it like it was yesterday. definitely interesting!
 
Mman said:
that would've been the most likely cause IMHO. Even something like catastrophic aspiration likely wouldn't cause death quickly, more just a massive hypoxic injury that would evolve over time in the ICU leading to brain death. MH can kill quickly even if correctly recognized and treated. It's rare, but it can happen.
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also consider the fact that these athletes tend to have a lot of muscle bulk = hyperthermia, hyperkalemia progresses very rapidly
 
dr doze said:
Just went to review the MHapp on my iPhone. Doesn't work. Apparently not compatible with current iPhone Operating System.

Get it together MHAUS. Some of us actually expect it to be there.
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We've got MH posters and placards plastered all around the OR suite and in every OR. We call MHAUS for help with case management if we have a suspected incident. And that info is all over the MHAUS website as well.
 
btbam said:
We do general for our teenage ACLs, but that's mostly cause we have a ****ty surgeon who does them.
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Are most doing a sciatic/fem or spinal?

I do all under GA with FNB
 
Man o War said:
Hmmm, now I’m wondering if I’m just really unlucky, or if there is some sort of documented regional difference in prevalence of MH.
I’ve also spent most of my career supervising 3-4 rooms, and tended to work a lot over the years. So my chances of seeing it have been higher than many I’d guess.
Click to expand...
I've never had a case personally - nearly 40 years in practice and avg 800-1000 cases/yr.

There are regional differences for sure. Also areas with higher incidence as Mr. S noted in his post, with "closer family ties" making it more likely.
 
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jwk said:
I've never had a case personally - nearly 40 years in practice and avg 800-1000 cases/yr.

There are regional differences for sure. Also areas with higher incidence as Mr. S noted in his post, with "closer family ties" making it more likely.
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According to UpToDate the incidence is only 1 per 100,000 anesthetics so with 800-1000 cases per year most of us will never see a single case.
 
algosdoc said:
Of course the "healthy" person may have cardiac issues or different electrophysiology of an elite athlete. I once did anesthesia for a UK starting basketball player for a knee arthroscopy and had massive BP and arrhythmia problems throughout the entire anesthetic. Would not have guessed it with a pre-op ECG that was completely normal.
Click to expand...

Why was there a preop ECG done on a young healthy basketball player for a knee scope?
 
BHM1 said:
Why was there a preop ECG done on a young healthy basketball player for a knee scope?
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My bro-in-law is a Medtronic Rep. He does ECG’s on every athlete that signs with LSU athletics every year. It’s school policy. They find all kinds of issues.
 
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