Search By Tags

© 2023 by "This Just In". Proudly created with Wix.com

Ludwig's. Not Van Beethoven.

April 19, 2016

 

CRAZY CASE. 

I SHOULD HAVE BEEN READY SOONER. There was no lumen that would have allowed any blade direct or video to enter her mouth. Naso fibroptics or surgical airway thru the neck were the only viable options.

I had oped she was going to the O.R. soon.

 

Hoped she was going to get the care she needed as soon as possible up in the O.R. 

She pooped out in front of me. She decompensated when I was least ready.

After refusing to see a doctor for one week of progressively worsening Ludwig's Angina. She had survived my care in getting a ct scan of the soft tissue neck done. She had survived a dentist/oromaxofacial surgeon consult and then ENT consult. Both agreed she needed the O.R. 

She could nod and shake her head for questions. You could barely hear her voice and understand her. 

 

The ENT attending who was going to operate on her, wanted to see the patient before taking her up to the O.R. Saw her with him. He saw her, and noted with me, she was now gasping for air, become agonal, and then stop breathing right in front of us. NOOOOOOOOOOOOOOOOOOOOOOOOOOO.

But he moved quickly and performed a slash tracheostomy. Pulse ox and ETCO2 detected but later no longer detected, but why?

 

The Anesthesiologist who was going to deal with her airway came down. wondering what had happened. Realized her airway was going to be a disaster when he saw her getting CPR.

 

Pt went into cardiac arrest from likely respiratory arrest. 

The only reason a pulse ox and a continous end tidal c02 didn't change color, even when the tube is in the trachea from surgical means, is cardiac arrest. If there is a pulse, you really question the ENT or surgeon or yourself the ED attending if you went in the right place. 

but proof was with cpr, pulse ox picked up, and pt had an ETCO2, and with fiberoptic scope the 6.0 ETT was noted in the trachea. Tracheal rings were seen.

I felt the tracheal rings with my finger thru the slash tracheostomy done by the ENT surgeon who was going to operate on her. 

 

But it was too late. Later found out from the son who had stepped away, that the patient had wished to be DNR/DNI but he had forgotten to tell me and my em resident.

We wept. She was alive and later wasn't. Then we saw the next patient. 

Please reload