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Ellefsen S, Kristensen MS. Postoperative Upper Airway Blood Clot After Tonsillectomy Requiring a Suction Catheter Without Side Holes for Removal: A Case Report. A A Pract 2024; 18:e01757. [PMID: 38373232 DOI: 10.1213/xaa.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
We present a case of acute dyspnea due to postoperative oral bleeding after tonsillectomy, wherein a blood clot obscured the laryngeal structures to such an extent that no recognizable structures could be identified. A larger-bore suction catheter without side holes proved necessary to solve the problem. The case illustrates how a gradually forming blood clot can remain asymptomatic until reaching a size where it poses an airway threat and highlights the necessity for readily available larger-bore suction devices without side holes. We consider this as an important reminder of the unpredictable nature of blood clot formation and its management.
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Affiliation(s)
- Sandra Ellefsen
- From the Department of Anesthesia and Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Michael Seltz Kristensen
- Department of Anesthesia and Operating Theatre Services, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
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Cochran-Caggiano N, Holliday J, Howard C. A Novel Intubation Technique: Bougie Introduction Via Ducanto Suction Catheter. J Emerg Med 2024; 66:221-224. [PMID: 38296765 DOI: 10.1016/j.jemermed.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/04/2023] [Accepted: 11/04/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Airway management is a defining skill that demands mastery by emergency physicians. Airway emergencies pose considerable morbidity and mortality risks. Familiarity with, and mastery of, a variety of airway management approaches and equipment can prove invaluable for management of anatomically and physiologically difficult airways. CASE REPORT A 67-year-old woman presented to a level II trauma after a motor vehicle collision. Emergency medical services reported left-sided injuries, including diminished breath sounds. She arrived in extremis with dyspnea and hypoxia refractory to supplemental oxygen. A portable chest x-ray study showed a considerable traumatic diaphragmatic hernia. Initial attempts at intubation via video laryngoscopy were unsuccessful. Difficulties were attributed to anatomic variation, possibly due to the traumatic diaphragmatic hernia, and hematemesis. The airway was repositioned after removal of a cervical collar and suction-assisted laryngoscopy airway decontamination was performed under video guidance. During airway decontamination, the tip of a DuCanto suction catheter (SSCOR) became located at the level of the vocal cords, prompting the decision to control the airway via utilization of the DuCanto suction catheter and a bougie. The suction tubing was disconnected, a bougie was inserted through the catheter, and the DuCanto was subsequently removed and replaced with a cuffed endotracheal tube. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Airway emergencies are imminent life threats. Familiarity with a variety of tools and techniques allows for definitive airway management via primary, back-up, and contingency plans to secure anatomically or physiologically difficult airway.
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Affiliation(s)
| | - Jordan Holliday
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Cory Howard
- Emergency Medicine Residency, HCA Florida Brandon Hospital, Brandon, Florida
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Root CW, Mitchell OJL, Brown R, Evers CB, Boyle J, Griffin C, West FM, Gomm E, Miles E, McGuire B, Swaminathan A, St George J, Horowitz JM, DuCanto J. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resusc Plus 2020; 1-2:100005. [PMID: 34223292 PMCID: PMC8244406 DOI: 10.1016/j.resplu.2020.100005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/09/2020] [Indexed: 11/25/2022] Open
Abstract
Emergency airway management is often complicated by the presence of blood, emesis or other contaminants in the airway. Traditional airway management education has lacked task-specific training focused on mitigating massive airway contamination. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed in order to address the problem of massive airway contamination both in simulation training and in vivo. We review the evidence describing the dangers associated with airway contamination, and describe the SALAD technique in detail.
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Affiliation(s)
- Christopher W Root
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM, 87106, USA
| | - Oscar J L Mitchell
- Division of Pulmonary, Allergy and Critical Care Medicine and the Center for Resuscitation Science, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19103, USA
| | - Russ Brown
- Southlake Fire Department, 600 State St, Southlake, TX, 76092, USA
| | - Christopher B Evers
- Department of Emergency Medical Services, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY, 11746, USA
| | - Jess Boyle
- School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11746, USA
| | - Cynthia Griffin
- University of Wisconsin Medflight, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Frances Mae West
- Division of Pulmonary, Allergy, and Critical Care Medicine, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Edward Gomm
- Department of Anaesthesia, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
| | - Edward Miles
- Department of Anaesthesia, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
| | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Anand Swaminathan
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, 703 Main St, Paterson, NJ, 07503, USA
| | - Jonathan St George
- Department of Emergency Medicine, Weill Cornell Medical College, 525 E 68th St, Room M130, New York, NY, 10065, USA
| | - James M Horowitz
- Department of Medicine, New York University Langone Health, 550 1st Avenue, 14th Floor, New York, NY, 10016, USA
| | - James DuCanto
- Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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Pilbery R, Teare MD. Soiled airway tracheal intubation and the effectiveness of decontamination by paramedics (SATIATED): a randomised controlled manikin study. Br Paramed J 2019; 4:14-21. [PMID: 33328824 PMCID: PMC7706770 DOI: 10.29045/14784726.2019.06.4.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Vomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest (OHCA), with a reported incidence of 20–30%. This is of concern since patients who have suffered an OHCA are already in extremis. If standard suctioning techniques are not sufficient to maintain a clear airway and provide ventilation, then these patients will die, irrespective of the quality of chest compressions and the timeliness of defibrillation. This study aimed to determine whether a short teaching session of the suction assisted laryngoscopy and airway decontamination (SALAD) technique improved paramedics’ ability to successfully intubate a contaminated airway. Methods: A modified airway manikin with the oesophagus connected to a reservoir of ‘vomit’, and a bilge pump capable of propelling the vomit up into the oropharynx, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB, who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition. Results: In this manikin study, following a brief SALAD training session, more paramedics were able to intubate a soiled airway on their first attempt, compared to those without training (90.2% vs. 53.7%, difference of 36.6%, 95% CI 24–49.1%, p < 0.001). In addition, the mean difference in time taken to perform a successful intubation between groups was statistically significant for attempts 1 and 2 (mean difference 11.71 seconds, 95% CI 1.95–21.47 seconds, p = 0.02), but not attempts 1 and 3 (mean difference –2.52 seconds, 95% CI –11.64–6.61 seconds, p = 0.58). This result is likely to be confounded by the use of tracheal suction, which only occurred in the post-training attempts and added additional time to the intubation attempts. There was no statistically significant difference in success rates on the third attempt between AAB and ABB (89.0% vs. 86.6%, difference 2.4%, 95% CI 7.6–12.4%, p = 0.63). Conclusion: In this study, the use of the SALAD technique significantly improved first attempt success rates when paramedics were intubating a simulated soiled airway.
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