Managing laryngospasm in the emergency department

It has now been a full year since I started First10EM. Thank you to everyone who has helped me a long the way, and especially to everyone who has spent their time reading this blog. I never imagined that so many people would be interested in my emergency medicine education project. This is an updated version of the first ever post on First10EM.com

Case

A feisty 3 year old tripped, cut her lip, and is now politely refusing your colleague’s attempts at suturing. You hear these polite refusals from across the department and wander over to offer your help with a procedural sedation. After moving to an appropriate room, going through the pre-sedation checklists, and tracking down all the folks that are required to be present, you give a dose of ketamine. Just as you are about to entertain the room with your latest cheesy joke, you hear a loud squeaking. You glance at the patient and recognize significant respiratory muscle contraction and stridor. A quick glance at the monitor shows a flat CO2 tracing. Oh no, laryngospasm…
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Management of severe anaphylaxis in the emergency department

A brief review of the management of the critically ill patient with anaphylaxis in the emergency department

Case

A 31 year old female is brought into the emergency department by ambulance after she collapsed at a family birthday party. She has a diffuse red rash, a blood pressure of 80/40, and an oxygen saturation of 88% on room air. She is wearing a medicalert bracelet. Her uncle guiltily admitted to EMS that he hadn’t told people that the vegan “cheese ball” he brought was actually just pureed nuts…

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Management of severe croup

A brief review of the management of the child with severe airway obstruction from croup in the emergency department

Case

Another night shift in the emergency department and you are 25 minutes into the history of a patient with 17 chief complaints when your phone rings. “You are needed in resus 3”. Initially, it feels good to be called away for a ‘real emergency’. However, when you lay eyes on the little girl, you kick yourself for that thought. Her mother says she has had a mild cough and runny nose for a few days, but tonight she developed a very harsh, barking cough and noisy breathing. Now she is barely making noise at all. The one year old in front of you is using every accessory muscle she has, breathing at least 60 times a minute, and the monitor shows an oxygen saturation of 88%.

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The bleeding tracheostomy

Case

On another shift, the 45 year old man with a tracheostomy from the prior case is brought back into the emergency room. This time, he is actively bleeding from his tracheostomy site…

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Respiratory distress in the patient with a tracheostomy

Case

A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respiratory distress. You know from prior conversations with the family that the patient is to receive full, aggressive medical management. He is using every accessory muscle that you can see, his respiratory rate is 55, and his oxygen saturation is 87% on room air…

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Massive Hemoptysis

A simplified approach to the initial assessment and management of emergency department patients with massive hemoptysis

Case

The charge nurse grabs your arm and pulls you into the resuscitation bay, where EMS have just unloaded a 45 year old guy in obvious distress, coughing up a significant amount of blood. The paramedic tells you, “He doesn’t speak English, so we don’t know a lot about him. My guess is that he has already coughed up about 250ml of blood on route. He still sating OK, and his pressure is holding, but I’m just glad we got here. He’s all yours doc…”

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Laryngospasm

A simplified approach to the management of laryngospasm in the emergency department

Case

A feisty 3 year old tripped, cut her lip, and is now politely refusing your colleague’s attempts at suturing. You hear these polite refusals from across the department, and wander over to offer your help with a procedural sedation. After moving to an appropriate room, going through the pre-sedation checklists, and tracking down all the folks that are required to be present, you give a dose of ketamine (1mg/kg IV). Just as you are about to entertain the room with your latest cheesy joke, you hear a loud squeaking. You glance at the patient and recognize significant respiratory muscle contraction and stridor. A quick glance at the monitor shows a flat CO2 tracing. Oh no, laryngospasm…

  Continue reading “Laryngospasm”