A&A practice
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A patient with ankylosing spondylitis in a "can't intubate, can't oxygenate" situation was rescued with cannula cricothyrotomy and transtracheal jet oxygenation. The case revealed clinical and systematic weaknesses, leading to standardization and reorganization of our equipment. ⋯ Cognitive aids specific to emergency front-of-neck access (eFONA) were created and placed strategically with the eFONA equipment to prompt and guide operators during airway emergencies. The aids have also been incorporated into our training curriculum to encourage their use.
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A 48-year-old woman with a history of cardiac surgery developed severe dyspnea and anxiety following right-sided supraclavicular nerve block for hand surgery. In this case, right phrenic nerve blockade from a supraclavicular block unmasked a subclinical hemidiaphragmatic paresis from phrenic nerve injury on the left, the latter likely due to previous cardiac surgery. When performing brachial plexus block at or above the clavicle, particularly for prior cardiothoracic surgical patients, anesthesiologists can easily, quickly, and inexpensively use point-of-care ultrasound to assess whether any degree of phrenic nerve dysfunction exists on the contralateral side, as patients may be asymptomatic at baseline.
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The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. ⋯ The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.