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A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management.

Birkholz T, Kröber S, Knorr C, Schiele A, Bumm K, Schmidt J - J Emerg Trauma Shock (2010)

Bottom Line: A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department.This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines.Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University Hospital Erlangen, Krankenhausstr. 12, D-91054, Erlangen, Germany.

ABSTRACT
A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

No MeSH data available.


Related in: MedlinePlus

Retropharyngeal hematoma (*) grossly dislocating the larynx (+) to the right at the level of the hyoid
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Figure 0001: Retropharyngeal hematoma (*) grossly dislocating the larynx (+) to the right at the level of the hyoid

Mentions: During ongoing laryngeal mask ventilation, the resuscitation team prepared for another intubation attempt. Laryngoscopy with a size four Macintosh blade revealed a grossly altered pharyngeal anatomy with circumferential hypopharyngeal swelling. The nodular altered and bleeding mucosa was reminiscent of a hypopharyngeal tumor. Laryngeal structures could not be identified. The outer neck showed a left-sided swelling and a marked dislocation of the larynx to the right [Figure 1], and especially the cricothyroideus membrane could not be identified clearly. The trauma surgeon resident present was instructed to prepare for emergency tracheostomy, as cricothyroidotomy was not considered possible.


A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management.

Birkholz T, Kröber S, Knorr C, Schiele A, Bumm K, Schmidt J - J Emerg Trauma Shock (2010)

Retropharyngeal hematoma (*) grossly dislocating the larynx (+) to the right at the level of the hyoid
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966579&req=5

Figure 0001: Retropharyngeal hematoma (*) grossly dislocating the larynx (+) to the right at the level of the hyoid
Mentions: During ongoing laryngeal mask ventilation, the resuscitation team prepared for another intubation attempt. Laryngoscopy with a size four Macintosh blade revealed a grossly altered pharyngeal anatomy with circumferential hypopharyngeal swelling. The nodular altered and bleeding mucosa was reminiscent of a hypopharyngeal tumor. Laryngeal structures could not be identified. The outer neck showed a left-sided swelling and a marked dislocation of the larynx to the right [Figure 1], and especially the cricothyroideus membrane could not be identified clearly. The trauma surgeon resident present was instructed to prepare for emergency tracheostomy, as cricothyroidotomy was not considered possible.

Bottom Line: A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department.This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines.Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, University Hospital Erlangen, Krankenhausstr. 12, D-91054, Erlangen, Germany.

ABSTRACT
A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

No MeSH data available.


Related in: MedlinePlus