Negative Pressure (neurogenic) Pulmonary Edema

[VentMonkey]

While the circumstances leading up to this case are unfortunate, even in spite of her full recovery, this is an interesting case to learn from and share with the group. The correlation with the two, and cascade of events leading up to this patients neurologically induced PE is something worth considering with any near-hanging patient regardless of provider level; definitely some good takeaways regarding treatments, and pathology:

http://www.airmedicaljournal.com/article/S1067-991X(16)30279-6/abstract

 

[E tank]

While the circumstances leading up to this case are unfortunate, even in spite of her full recovery, this is an interesting case to learn from and share with the group. The correlation with the two, and cascade of events leading up to this patients neurologically induced PE is something worth considering with any near-hanging patient regardless of provider level; definitely some good takeaways regarding treatments, and pathology:

http://www.airmedicaljournal.com/article/S1067-991X(16)30279-6/abstract

Ughhh...horrifying.

But the authors make a confusing statement that bears clarification. Under the "pulmonary complications of near hanging" section, they differentiate neurogenic cause and intrathoracic pressure cause of pulmonary capillary integrity failure.

They say that "increased intrathoracic pressure" causes it and further along they say "increased negative intrathoracic pressure", implying both cause this type of lung injury. It's only severe negative intrathoracic pressure caused by herculean attempts at inspiration against a closed glottis that brings about this type of ALI.

A minor point but one that could be confusing, so there it is.

Hope the kid did OK later too.

 

[VentMonkey]

Thanks for the input, tank. It definitely caught my eye, and not something I'd think everyday field providers such as myself would keep in the back of their minds when "learning to tube".

I'm all for encouraging providers such as myself with topics like this. "Just getting the tube" is hardly the end goal of ETI regardless of the provider level from paramedics on up.

Reading, learning, and sharing insightful examples such as this further serve as worthwhile, and remarkable proof that airway management is often an all encompassing procedure from the very beginning until the end, i.e., extubation to discharge.

I still like to think the end-goal of any person performing an ETI (not including the non-viable) should be a timely extubation. Which means proper fundamentals all the way through.

 

[FLMedic311]

@VentMonkey Interesting little tidbit at the end about a correlation between the use of ketamine and Pulmonary Edema, the study appeared limited and ex vivo but I had never heard of this before. I have heard of the possibility of increased oral secretions, especially in kids and was wondering is this via the same mechanism or if you have more insight? Thanks for the case it was a good read!!