"A Pain in the Neck"
|Case||717||1||February 25, 2009|
This is a high-fidelity simulation case presentation of a 64 year-old female who presents via EMS with a chief complaint of "trouble breathing" and swelling in the neck. Initial vital signs are stable. The condition progresses to acute respiratory distress secondary to progressive expansion of neck mass shortly after arrival. Anesthesia/ENT consultants are unavailable. The learner must proceed to intubation of the difficult airway.
Wang E, Vozenilek J. "A Pain in the Neck". MedEdPORTAL; 2009. Available from: www.mededportal.org/publication/717
- Airway Obstruction (MeSH), Neck Injuries (MeSH), Respiratory Distress (MeSH), Intubation (MeSH)
- Emergency Medicine
- Interpersonal & Communication Skills
- Medical Knowledge
- Patient Care
- Practice-based Learning & Improvement
- Clinical Sciences
- Clinical Exam
- Clinical Skills/Doctoring
- Communication Skills
- Evaluation of Clinical Performance
- Instructional Materials/Methods
- Professional School
- Medical Student
- Professional School Post-Graduate Training
- Problem-based Learning
Authors & Co-Authors
Northwestern University, The Feinberg School of Medicine
John Vozenilek, MD
Northwestern University: The Feinberg School of Medicine
Effectiveness and Significance
The case presents a rare presentation of an expanding neck mass secondary to ruptured inferior thyroid artery aneurysm. The patient subsequently deteriorates and requires definitive airway management. This case presents an opportunity for medical students and emergency medicine residents to experience a true difficult airway and allows them to practice a difficult airway algorithm as well as life-saving, time-sensitive airway procedures without putting the patient at risk.
Special Implementation Guidelines or Requirements
Other than a high fidelity simulator set up, you will need difficult airway equipment, an extra monitor or computer to show the radiographic stimuli.
As the primary caretaker for the case in real life, I have tried to impart on the learners several critical issues related to difficult airway management:
- How do you recognize the difficult airway?
- When is it contraindicated or relatively contraindicated to paralyze a patient with an expanding neck mass?
- What are your difficult airway adjuncts and do you have an algorithmic approach to this process? We have mocked up the neck on the mannequin for the case by placing a sponge or a rolled up latex glove to simulate the neck mass and this seems to add realism to what the learner visualizes.
This information is made available under the Creative Commons license.