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Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/524

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Title: Massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum after multiple direct laryngoscopies: an autopsy case report
Authors: Ono, Yuko
Okubo, Yoshinori
Hashimoto, Katsuhiko
Inokuchi, Ryota
Odajima, Hajime
Tase, Choichiro
Shinohara, Kazuaki
Affiliation: 救急医療学講座
Source title: Journal of anesthesia
Volume: 29
Issue: 4
Start page: 622
End page: 626
Issue Date: Aug-2015
Abstract: Multiple endotracheal intubation (ETI) attempts increase the risk of airway-related adverse events. However, little is known about autopsy findings after severe ETI-related complications. We present the detailed pathological findings of a case with severe ETI-related complications. A 77-year-old obese male suffered cardiopulmonary arrest after choking at a rehabilitation facility. Spontaneous circulation returned after chest compressions and foreign-body removal. After multiple failed direct laryngoscopies, the patient was transferred to our hospital. He had massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum on admission and died from hypoxic brain injury 15 hours later. Autopsy revealed severe oropharyngeal; laryngeal; and left lung lower lobe injury. The likely mechanisms of diffuse emphysema were: 1) oropharyngeal injury associated with multiple ETI attempts and excessive ventilation pressures and 2) left lung lower lobe injury associated with chest compressions and other resuscitative procedures. Multiple laryngoscopies can cause severe upper-airway injury, worsen respiratory status, and make ETI more difficult—a vicious circle that can be prevented by limiting ETI attempts. This is particularly important in unfavorable environments, in which backup devices and personnel are not easily obtained. The pathological findings of our patient caution against repeated attempts at ETI during resuscitation.
Publisher: Springer
language: eng
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/524
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/524/1/JAnesth_29_p622.pdf
ISSN: 0913-8668
1438-8359
DOI: 10.1007/s00540-015-1997-9
PubMed ID: 25784502
Other version: http://dx.doi.org/10.1007/s00540-015-1997-9
Rights: © Japanese Society of Anesthesiologists 2015. The final publication is available at link.springer.com.
Appears in Collections:a10 学術雑誌論文等 = Journal Article

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JAnesth_29_p622.pdf393.54 kBAdobe PDFDownload

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