What happened here?

[ProRealDoc]

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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.

 

[Jeff05]

Tension PTX

 

[SleepIsGood]

Did the 14G needle hit one of the Great Vessels man?

Widened mediastinum.

 

[pgg]

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.

 

[ProRealDoc]

Did the 14G needle hit one of the Great Vessels man?

Widened mediastinum.

Nope. 14g was placed therapeutically.

 

[ProRealDoc]

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.

2nd intercostal space, midclavicular line

 

[rocuronium]

The green stopcock is in the wrong position.

 

[urge]

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.

 

[ProRealDoc]

The green stopcock is in the wrong position.

why?

 

[ProRealDoc]

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.

What's wrong with trying to get central access in that fashion? 😀


trach was fresh.

 

[pgg]

2nd intercostal space, midclavicular line

Is that where you connected the jet ventilator? 🙂

 

[rocuronium]

why?

Isn't that stopcock closed to the pneumothorax?

 

[huktonfonix]

thats what happens when you dont allow for exhalation during jet ventilation.

 

[ProRealDoc]

Isn't that stopcock closed to the pneumothorax?

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

 

[ProRealDoc]

Is that where you connected the jet ventilator? 🙂

 

[rocuronium]

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

Gotcha.

 

[Noyac]

SubQ emphysema

 

[ProRealDoc]

SubQ emphysema

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