Close Call In Honduras With A Nosebleed

I recently visited Honduras with a Head and Neck surgical team where we had a close call with a potential airway obstruction due to a blood clot. The case illustrates how a provider should never make assumptions, because if those assumptions are wrong, you can endanger your patient.

After a long day in the OR, while we were packing up to leave, a nurse from the ward ran in and said that one of the patient’s who had had a septoplasty that day for chronic sinusitis was bleeding. I immediately started setting up the OR again while our surgeon went over to the ward. Continue reading

Intubation With Airway Bleeding and Massive Emesis

During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse airway bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? Here I describe two cases, one involving blood and the other massive emesis, that required intubation through a large puddle of fluid. I offer tips and tricks to assist you in your future emergency management. Continue reading

Plastic In the Airway: An Unsuspected Aspiration Hazard

I saw a potential aspiration hazard in the OR today. How many times a day do we routinely peel plastic wrappers off of airway equipment? If I’m at the surgicenter, I might need 7 face masks, a variety of LMAs and endotracheal tubes and an oral airway or two.

Take a look at the typical plastic wrapped mask here in this photo. We unwrap these sorts of objects dozens of times a day.

photo of Typical plastic wrapped disposable mask

Typical plastic wrapped disposable mask.

Here is the same mask unwrapped. Do you see the hazard I found?

photo of Same unwrapped mask with an almost invisible hazard

Same unwrapped mask with an almost invisible aspiration hazard inside.

Here it is, a tiny piece of torn plastic that was stuck to the inside of the mask. It’s almost invisible unless you look for it.

Photo of an aspiration hazard: a bit of plastic wrap stuck inside the mask

Aspiration hazard: a bit of plastic wrap stuck inside the mask

Look back at the wrapped mask. Do you see it now?

Arrow points at aspiration hazard inside the mask

Arrow points at aspiration hazard inside the mask

Aspirating something like this could have serious consequences. In anesthesia, or any field of medicine, the devil is in the details. You cannot be too compulsive about safety. Check and recheck everything. Every little bit counts.

May The Force Be With You

Christine Whitten MD