thebluntdissection

pulling apart cases from the ED...

  • Home
  • About
  • EMUGs
  • Fellowship Flashcards
  • Contact

a difficult airway…

October 26, 2012 By Christopher Partyka Leave a Comment

The Case.

The ‘Batphone’ alerted us of a 68 year old female who is postictal following two seizures in rapid succession. She has a history of ‘a brain tumour’.

P 120. BP 176 systolic !! GCS 8/15. Afebrile. Sats 98% (15L NRB + guedel airway).

She arrives direct to your resus bay 4-5 minutes later and she is actively seizing.

A) Obstructed (Guedel on floor). Trismus ++.

  • Bilateral nasopharyngeal airways inserted
  • Two-handed jaw thrust
  • Ventilating well on 100% BVM.

 B) Bilateral air entry. Sats 99% on O2. No added sounds.

 C) P 130 (sinus) BP 185 systolic. Diaphoretic. Warm peripheries.

  • 2x IVC inserted
  • 500mL N.Saline bolus

D) Actively seizing (GTCS with movement in all 4 limbs). Pupils 4mm (L+R).

  • 2x 5mg IV Midazolam (seizure resolved)
  • 1gram IV Phenytoin (loading commenced at cessation of seizure)

E) Temp 37*C. BSL 13. No rashes, contusions etc.

Impression:

Status Epilepticus (3x seizures with no return to normal mental state)

  • ? secondary to ‘brain tumour’ or associated haemorrhage
  • No other medical history available
  • “Family are bringing in her medications”

Following resolution of her seizure she remains obtunded, GCS (E1V1M4) 6/15 and still obstructing her airway. A decision is made to RSI for airway control and prevention of secondary brain injury, followed by urgent CT. [Read more…]

Filed Under: Airway, Reflection Tagged With: airway, can't intubate can't ventilate, cricothyrotomy, reflection, surgical airway

Recent Posts

  • an abominable airway…
  • shrouded shock…
  • another bubble of trouble…
  • bubble of trouble…
  • collective crises…

RSS Life in the Fast Lane • LITFL

  • Funtabulously Frivolous Friday Five 352
  • Comms Lab: I-Messages
  • Adult CXR Cases 028
  • Claus Bang
  • Merry Funtabulously Frivolous Friday Five 351

Follow me on Twitter

My Tweets

© 2012–2023 · Hosted by LITFL