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What happened here?

Discussion in 'Anesthesiology' started by ProRealDoc, Jan 5, 2009.

  1. ProRealDoc

    ProRealDoc ASA Member
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    60+ y/o patient in for abdominal procedure with your typical comorbidities Dm, HTN, etc.

    In OR patient is induced, unable to intubate/ventilate, emergency crycothyroidotomy is performed with 14g angiocath placed and jet ventilation initiated. Patient then trached.

    You then receive patient in PACU from your attending and patient is noted to be hypotensive, tachycardic and tachypneic.

    [​IMG]

    [​IMG]
     
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  3. Jeff05

    Jeff05 Senior Member
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    Tension PTX
     
  4. SleepIsGood

    SleepIsGood Support the ASA !
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    Did the 14G needle hit one of the Great Vessels man?

    Widened mediastinum.
     
  5. pgg

    pgg Laugh at me, will they?
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    Weren't these photos posted in another thread recently? They look familiar.

    With that xray after jet ventilation, pneumomediastinum would top my list.

    A bit hard for me to get oriented in the 2nd picture, but the needle looks more medial than I'd expect for this to be just an ordinary PTX.
     
  6. ProRealDoc

    ProRealDoc ASA Member
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    Nope. 14g was placed therapeutically.
     
  7. ProRealDoc

    ProRealDoc ASA Member
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    2nd intercostal space, midclavicular line
     
  8. rocuronium

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    The green stopcock is in the wrong position.
     
  9. urge

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    That's an odd place for an IV-- just kidding.

    Why is there so much blood on the neck. Is that open skin? Looks like you filleted his neck.
     
  10. ProRealDoc

    ProRealDoc ASA Member
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    why?
     
  11. ProRealDoc

    ProRealDoc ASA Member
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    What's wrong with trying to get central access in that fashion? :D


    trach was fresh.
     
  12. pgg

    pgg Laugh at me, will they?
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    Is that where you connected the jet ventilator? :)
     
  13. rocuronium

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    Isn't that stopcock closed to the pneumothorax?
     
  14. huktonfonix

    huktonfonix board certified!
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    thats what happens when you dont allow for exhalation during jet ventilation.
     
  15. ProRealDoc

    ProRealDoc ASA Member
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    it was closed when repeat CXR came back looking like this:

    [​IMG]
     
  16. ProRealDoc

    ProRealDoc ASA Member
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    :laugh:
     
  17. rocuronium

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    Gotcha.
     
  18. Noyac

    Noyac ASA Member
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    SubQ emphysema
     
  19. ProRealDoc

    ProRealDoc ASA Member
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    Funny no one else mentioned it even though it is obviously there.
     

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