TLDR: Pt went in for an emergency Tracheostomy due to neck swelling from a tooth abscess. Pt stopped ventilating AFTER the trach was set up and coded resulting in anoxic brain injury. The cause was bilateral lunch clots in the main stems blocking air flow. Neither the Anesthesiologist or ENT had seen this in 30 years of practice each.
So I’m going to start off and say the obvious: I’m not a doctor. I’m an SICU nurse with very limited experience.
Hx: 56yo male had an abscessed tooth removed two weeks ago. He was then admitted to a hospital for IV ABX one week ago for a growing infection in his neck and was released on oral ABX. He was then readmitted to that hospital days later and transferred to my hospital for our ENT doctor.
Pt was in the SICU with a CC of dyspnea r/t inflammation in the neck and floor of the mouth. When I assessed him he was AOx4, hypertensive (180-240 systolic), clear lung sounds, and pain 10/10 not helped by 4mg morphine q4hr.
3 hours later his lung sounds began to deteriorate. Wheezing started on the left and soon moved bilaterally. 1 hour later, audible stridor was heard. I escalated during all of this and he was assessed by the Hospitalist, Critical Care, Nephro, and ENT.
We prepped for an emergency Trach and he was sent off.
The trach was placed without incident with a total blood lost estimate of 25ml. Soon after placement, the pt suddenly stopped ventilating and became bradycardic and went into CA. The ENT and Anesthesiologist eventually found the cause to be blood clots blocking the main stems of the lungs.
The block clots were lavaged out with one being 4 inches long and significant in diameter.
24 hours after the incident, the pt has no purposeful movements and sluggish brain activity. He decorticate postures to painful stimulus and we had to paralyze him to remove his tongue from his locked jaw that he regularly grinds or chews.
The ENT and Anesthesiologist had never seen this in 30 years of practice each and a colleague had seen it once in his career.
I’m not asking any questions because I don’t know what to ask. It’s an incredibly rare and bizarre situation as I understand it and no one knows where the clots came from that possibly ended this mans life.
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