Journal of Emergencies, Trauma, and Shock
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LETTERS TO EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 164-165
An evolving difficult airway


Emergency Department, Kozhikode District Co-operative Hospital, Kozhikode, Kerala, India

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Date of Submission30-Apr-2017
Date of Acceptance07-Jun-2017
Date of Web Publication8-Aug-2017
 

How to cite this article:
Mohan N M, Linu S M. An evolving difficult airway. J Emerg Trauma Shock 2017;10:164-5

How to cite this URL:
Mohan N M, Linu S M. An evolving difficult airway. J Emerg Trauma Shock [serial online] 2017 [cited 2019 Jun 25];10:164-5. Available from: http://www.onlinejets.org/text.asp?2017/10/3/164/212503


Dear Editor,

Retropharyngeal hematoma causing airway obstruction following blunt trauma is a rare but life-threatening condition.[1],[2],[3],[4] We report the case of a 55-year-old moderately built male who developed upper airway obstruction due to retropharyngeal hematoma following a motor vehicle accident. On reaching the emergency department. (ED), the patient was restless, agitated, and intoxicated with ethanol. The primary survey was unremarkable with normal vital signs and a negative extended focused assessment with sonography in trauma. A. computed tomography. (CT) head and C-spine were ordered but could not be done as he developed respiratory distress while in the radiology department. He was rapidly desaturating and required rapid sequence intubation. However, on laryngoscopy, the vocal cords could not be visualized. A bougie-assisted intubation and even bag mask ventilation failed. A surgical cricothyroidotomy was done for adequate ventilation. X-ray cervical spine lateral film showed increased soft-tissue density anterior to the vertebral column completely obstructing the upper airway suggestive of a retropharyngeal hematoma [Figure 1]. CT head and cervical spine showed no intracranial injury, but a retropharyngeal hematoma extending from C2 to C6 vertebra without any fractures in vertebral bodies [Figure 2]. The patient developed no further complications and was discharged on day 6 from the hospital. A study by Nørskov et al. has shown that difficult airways cannot be always predicted.[5] It is safer to assume that every airway in ED is going to be challenging and be prepared with multiple backup plans. Preparation is the key for the success of any emergency procedure. Surgical cricothyroidotomy is a lifesaving emergency procedure which every clinician should be proficient in.
Figure 1: X-ray cervical spine lateral film showing increased soft-tissue density anterior to the vertebral column suggestive of a retropharyngeal hematoma completely obliterating the upper airway

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Figure 2: Computed tomography cervical spine showing retropharyngeal hematoma measuring 3 cm × 5.1 cm × 6 cm extending to paravertebral space, superiorly to C2 vertebra and inferiorly to C6 vertebra, displacing the Ryles tube anteriorly and without any obvious fractures, subluxation, or dislocations in the vertebral bodies

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Acknowledgment

Dr. Arun Sivashankar, doctors and nursing staff of ED of Kozhikode District Cooperative Hospital, senior and junior residents of ED of Government Medical College, Kozhikode, Kerala, India, for supporting us in the management of this patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Thomás MD, Torres A, García-Polo J, Gavilán C. Life-threatening cervico-mediastinal haematoma after carotid sinus massage. J Laryngol Otol 1991;105:381-3.  Back to cited text no. 1
    
2.
Muñoz A, Fischbein NJ, de Vergas J, Crespo J, Alvarez-Vincent J. Spontaneous retropharyngeal hematoma: Diagnosis by mr imaging. AJNR Am J Neuroradiol 2001;22:1209-11.  Back to cited text no. 2
    
3.
Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: Analysis of 27 patients reported in the literature. Anesthesiology 2006;105:1238-45.  Back to cited text no. 3
    
4.
Senel AC, Gunduz AK. Retropharyngeal hematoma secondary to minor blunt neck trauma: Case report. Rev Bras Anestesiol 2012;62:731-5.  Back to cited text no. 4
    
5.
Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: A cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia 2015;70:272-81.  Back to cited text no. 5
    

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Correspondence Address:
N Midhun Mohan
Emergency Department, Kozhikode District Co-operative Hospital, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_41_17

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