July 2013 critical care case of the month: the fortuitous critical care consult

Abstract

No abstract available. Article truncated at 150 words. History of Present Illness A 70 year old male with squamous cell cancer of the hypopharynx had undergone a laser ablation and debridement as an outpatient. The ENT surgeon placed a # 6 Shiley DCT tracheostomy tube and the patient did well after the procedure. His chest x-ray after the procedure revealed right lower lobe atelectasis but was interpreted as otherwise normal (Figure 1). Figure 1. Portable chest-ray after laser ablation and tracheostomy placement. Due to aspiration and feeding issues, he was scheduled 2 weeks later for percutaneous endoscopic gastrostomy (PEG) tube placement as an outpatient. However, the gastroenterologist cancelled the procedure due to copious secretions from tracheal site, described as purulent and some mild respiratory distress. He was admitted to the general medicine service at the Phoenix VA Medical Center. Physical Examination On examination of the patient, was non-toxic, talking, and alert. Vital signs were within normal limits, but …

Keywords

• tracheostomy
• empyema
• pleural effusion
• pneumonia
• aspiration pneumonia
• complication
• DNAase
• tissue plasminogen activator
• pleural fluid drainage
• thoracostomy