คนที่ 2 ได้ตรง While still in the ED, the decision was made with
the trauma surgeon to perform a cricothyrotomy. The
patient’s trachea was in the midline; however, because
of extensive edema and disfiguration of her neck, it
was difficult to evaluate and appreciate any anatomical
landmarks. Neck mobility was also impaired. With much
difficulty, the trachea was identified with a needle and
syringe. A guidewire was passed through the needle into
the trachea. At this point, the patient’s respirations were
rapid and shallow, and her Spo2 was approximately 60%.
The surgeon was unable to pass the tracheal dilator and
tracheostomy tube, so the needle and guidewire were
removed, and a direct cut down into the trachea was performed.
A 5.5-mm endotracheal tube (ETT) was inserted
into the trachea, and the cuff was inflated to a minimally
occlusive volume. She was ventilated with 100% oxygen.
Bilateral breath sounds and end-tidal carbon dioxide
were present.
Once the ETT was in place, the patient’s Spo2 returned
to approximately 96%. With positive pressure ventilation,
her chest excursion improved, but chest compliance
was decreased. As care continued, the patient experienced
oxygen desaturation falling to 40%, even following
suctioning. We suspected that the ETT had migrated into
the right bronchus because of difficulty in securing the
ETT to the patient’s swollen, blistered neck. The ETT was
cautiously repositioned, and she was aggressively ventilated
until her Spo2 rose to 90%.