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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

Endotracheal tube entering the tracheal lumen through tracheostomy (arrow), compressed by a large retropharyngeal–mediastinal hematoma (*) at the level of Th 2
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Figure 0002: Endotracheal tube entering the tracheal lumen through tracheostomy (arrow), compressed by a large retropharyngeal–mediastinal hematoma (*) at the level of Th 2

Mentions: In the meantime, an experienced surgeon had arrived and started the emergency tracheostomy. Tracheostomy was technically difficult, and hypoxemic cardiac arrest occurred. After a few minutes with intermitting thorax compression and 1 mg of adrenaline, tracheostomy of a grossly rightly dislocated and proximally compressed trachea succeeded with the insertion of a 6-mm I.D. Magill endotracheal tube. The site of tracheostomy was atypical and ranged into the upper thoracic aperture [Figure 2]. Ventilation was only possible with a deeply introduced endotracheal tube.


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)

Endotracheal tube entering the tracheal lumen through tracheostomy (arrow), compressed by a large retropharyngeal–mediastinal hematoma (*) at the level of Th 2
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Endotracheal tube entering the tracheal lumen through tracheostomy (arrow), compressed by a large retropharyngeal–mediastinal hematoma (*) at the level of Th 2
Mentions: In the meantime, an experienced surgeon had arrived and started the emergency tracheostomy. Tracheostomy was technically difficult, and hypoxemic cardiac arrest occurred. After a few minutes with intermitting thorax compression and 1 mg of adrenaline, tracheostomy of a grossly rightly dislocated and proximally compressed trachea succeeded with the insertion of a 6-mm I.D. Magill endotracheal tube. The site of tracheostomy was atypical and ranged into the upper thoracic aperture [Figure 2]. Ventilation was only possible with a deeply introduced endotracheal tube.

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