Cricothyrotomy Following Airway Hemorrhage from a Hypopharyngeal Cancer: A Clinical Case Study
A Physician Assistant's First Encounter with an Emergency Surgical Airway
Keywords:Upper Airway Hemorrhage, Physician Assistants, Cricothyrotomy
This clinical study describes an emergency cricothyrotomy on a hospital inpatient awaiting major head and neck surgery for a hypopharyngeal cancer. The clinical presentation of this patient highlights the emergent interventions for a bleeding upper airway, that can quickly lead to complete airway obstruction. Early recognition of an unstable airway is critical for patient outcomes in the head and neck cancer population.
Langvad S, Hyldmo PK, Nakstad AR, Vist GE, Sandberg M. Emergency cricothyrotomy - a systematic review. Scand J Trauma Resusc Emerg Med [Internet]. 2013 May [cited 2021 May 6];43(21). Available from: https://doi.org/10.1186/1757-7241-21-43.
Kwon YS, Lee CA, Park S, Ha SO, Sim YS, Baek MS. Incidence and outcomes of cricothyrotomy in the “cannot intubate, cannot oxygenate” situation. Medicine [Internet]. 2019 Oct [cited 2021 May 6];98(42). Available from: doi: 10.1097/MD.0000000000017713.
Kristensen MS, McGuire B. Managing and securing the bleeding upper airway: a narrative review. Can J Anesth/J Can Anesth [Internet]. 2020 Jan [cited 2021 May 6]; 67:128-140. Available from: https://doi.org/10.1007/s12630-019-01479-5.
PulmCrit (EMCrit) [Internet]. c2018. PulmCrit - Drowned Airway Algorithm: Cut to the Chase; 7 May 2018 [cited 2021 May 6];[about 13 screens]. Available from: https://emcrit.org/pulmcrit/drowned-airway-algorithm/.
EmDocs [Internet]. c2015. The Sphincter Series - Emergent Cricothyrotomy; 5 Aug 2015 [cited 2021 May 6];[about 15 screens]. Available from: http://www.emdocs.net/the-sphincter-series-emergent-cricothyrotomy/.
Endermann S, Korte W, Filipovic M. Airway obstruction caused by hemorrhage: managing a life-threatening complication in patients with acquire hemophilia A: a case report. A A Pract [Internet]. 2020 Feb 1 [cited 2021 May 6];14(3):83-86. Available from: doi: 10.1213/XAA.0000000000001155.
Gilard-Pioc S, Guerard P, Paraf F, Francois-Purrsell I. Sudden death by spontaneous epiglottic hematoma secondary to high blood levels of warfarin. J Forensic Sci [Internet]. 2017 Jul [cited 2021 May 6];62(4):1094-1096. Available from: doi: 10.1111/1556-4029.13384.
Whitten, C [Internet]. c2017. Intubation with Airway Bleeding and Massive Emesis; 13 May 2017 [cited 2021 May 6];[about 7 screens]. Available from: https://airwayjedi.com/2017/05/13/intubation_airway-bleeding-massive-emesis/.
Bernard EBG, Ervin AT, Mabry RL, Bebarta VS. Prehospital and en route circothyrotomy performed in the combat setting: a prospective, multicenter, observational study. J Spec Oper Med [Internet]. 2014 [cited 2021 May 6];14(4):35-9. Available from: PMID: 25399366.
Kim KN, Lee HJ, Choi HI, Kim DW. Airway management in patient with continuous bleeding lesion of the trachea: a case report. Korean J Anesthesiol [Internet]. 2015 Aug [cited 2021 May 6];68(4):407-10. Available from: doi:10.4097/kjae.2015.68.4.407.
Schauer SG, Bellamy MA, Mabry RL, Bebarta VS. A comparison of the incidence of cricothyrotomy in the deployed setting to the emergency department at a level 1 military trauma centre: a descriptive analysis. Mil Med [Internet]. 2015 Mar;180(3 Suppl):60-3. Available from: doi: 10.7205/MILMED-D-14-00384.
How to Cite
Copyright (c) 2021 Natalie Dies, CCPA, Jin Soo Andy Song, MD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors published in the Journal of Canada's Physician Assistants (JCanPA) retain copyright of their articles, including all drafts and final published version. By agreeing to publish in JCanPA, authors grant the journal the right of first publication and distribution rights of the articles. Authors are free to submit their work to other publications in addition to JCanPA, provided they acknowledge its initial publication in JCanPA.
JCanPA is published online in the public domain. JCanPA holds no legal responsibility as to how these materials are used by the public. Please ensure all authors, co-authors, and investigators have read and agree to these terms.