Annals of emergency medicine
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Case Reports
Unrecognized esophageal intubation with both esophageal obturator airway and endotracheal tube.
Two trauma patients with fatal injuries had unrecognized esophageal insertion of an endotracheal (ET) tube despite the presence of an esophageal obturator airway (EOA). Prehospital training must emphasize clinical verification of correct airway placement. ⋯ The EOA does not necessarily guide the ET tube into the trachea. Difficulty removing an EOA after insertion of an ET tube may indicate that both are in the esophagus.
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Acute epiglottitis may be more common in adults than is generally believed, but the diagnosis is often missed. Three cases of adults with epiglottitis are reported. ⋯ The diagnosis was established in each case by mirror or flexible fiberoptic laryngoscopy, lateral neck radiographs, or both. Treatment consisted of maintenance of a patent airway and administration of humidified oxygen and antibiotics.
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The technique of prehospital airway management is determined largely by the level of training and expertise of the prehospital care provider. We report preliminary observations and data in experimental animals and patients using a new airway adjunct--the pharyngeo-tracheal lumen (PTL) airway. The PTL airway employs a two-tube, two-cuff system that is inserted in a "blind" fashion. ⋯ Volumetric efficiency at optimal cuff inflation pressures was 100%, and arterial blood gas values obtained during PTL ventilation were not significantly different from those measured during ventilation with an endotracheal tube at comparable minute ventilations. In six arrest patients undergoing cardiopulmonary resuscitation, arterial PO2 and PCO2 using the PTL airway (176 +/- 105 mm Hg and 36 +/- 12 mm Hg, respectively) were not significantly different from those measured during artificial ventilation with an endotracheal tube (PO2, 162 +/- 124 mm Hg; PCO2, 34 +/- 10 mm Hg). Although the numbers are small, the data suggest that the PTL airway may be an alternative method of emergency airway management when endotracheal intubation cannot be performed.
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An unusual case of intra-articular patellar dislocation is described in which the patella rotated simultaneously in both the horizontal and vertical axes. The dislocation was sustained without apparent trauma. Reduction could not be accomplished in the emergency department. Closed reduction was accomplished successfully under general anesthesia in the operating room.
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To assess the treatment of intentional insulin overdoses with intravenous (IV) glucose, we reviewed the records of 17 attempts in 15 patients seen during a ten-year period. The mean age of our patients was 29 +/- 9 years, and the mean overdose of insulin was 386 +/- 276 units. Eight patients were insulin-dependent diabetics and seven patients had no history of diabetes. ⋯ No patient sustained permanent complications from hypoglycemia. We conclude that prolonged, aggressive IV glucose infusion and serial monitoring of serum glucose levels is required in insulin overdoses. These patients may become hypoglycemic much later than predicted from the conventional duration of action of the various insulin preparations.