Lessons from the Field: Unusual Problems Require Unusual Solutions in Impossible Situations
You are stationed in a cottage/mission hospital in Africa as the anesthesiologist. You are called to anesthetize a 35-yr-old healthy male who has been stabbed in the neck with a wooden knife. You run to the emergency room and find the patient in stable condition. He is awake and cooperative. The wooden knife’s handle is visible sticking out of his neck with the wooden blade disappearing under the clavicle, directed toward the heart. He is otherwise healthy, with no previous surgeries or allergies to drugs. The surgeon wants to remove the knife under general anesthesia. You send off blood for cross matching and place two large-bore IVs. The patient is taken to the operating room. After 4 U of blood are made available in the operating room, you anesthetize him with a rapid sequence technique. He tolerates the anesthetic induction well, and his vital signs remain unchanged. The surgeon cleans the neck and pulls out the wooden knife. There is sudden tachycardia with a dramatic drop in blood pressure. Severe bleeding is seen from the neck wound. The surgeon now does a sternotomy and discovers to everyone’s dismay that there is a 0.5–1-cm hole in the aortic arch between the innominate and the left common carotid arteries. Your training dictates that the patient be placed immediately on cardiopulmonary bypass, but you know there is no such thing available. What do you think the surgeon can do to save this patient’s life?
KeywordsAortic Arch Blood Bank Innominate Artery Anesthetic Induction Neck Wound
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