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Middle-Aged Male With Right Neck Pain
IMAGES IN EMERGENCY MEDICINE Zhongliang He, MD; Geng Zhang, MD; Guoxing Chen, MD; Xueming He, MD 0196-0644/$-see front matter Copyright © 2017 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2017.03.067
Figure 1. CT of the neck (axial view) showing a gas-forming abscess involving the right side of the neck (arrow). Figure 2. CTof the chest (axial view) showing a gas-forming abscess extending into the right anterosuperior mediastinum (arrow).
Figure 3. Swelling, redness, and left deviation of the trachea (arrow) just before cervicotomy.
Figure 4. Contrast-enhanced CT of the neck and chest (coronal view) showing resolution of the abscess, with persistent thrombosis of the right internal jugular vein (arrow) on postoperative day 38.
[Ann Emerg Med. 2017;70:463.] A 45-year-old man with a history of odontalgia presented to our hospital because of fever, dysphagia, dyspnea, hoarse voice, and right-sided neck pain for 4 days. The physical examination revealed a temperature of 39.4 C (102.9 F) and right-sided neck swelling, redness, and stiffness. Laboratory testing revealed a WBC count of 22.9109/L. Ultrasonography of the neck was suspicious for thrombosis of the right internal jugular vein. Computed tomography (CT) of the neck and chest showed abscesses involving the right side of the neck and the anterosuperior mediastinum (Figures 1 and 2). For the diagnosis and teaching points, see page 494. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 70, no. 4 : October 2017
Annals of Emergency Medicine 463
Effectiveness of Apneic Oxygenation During Intubation 27. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877-1887. 28. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574-583. 29. Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med. 2016;193:273-280. 30. Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care. 2016;61: 1160-1167. 31. Vourc’h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41: 1538-1548. 32. Fogg T, Alkhouri H, Vassiliadis J. The Royal North Shore Hospital Emergency Department airway registry: closing the audit loop. Emerg Med Australas. 2016;28:27-33. 33. Grant S, Khan F, Keijzers G, et al. Ventilator-assisted preoxygenation: protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emerg Med Australas. 2016;28:67-72.
494 Annals of Emergency Medicine
Oliveira J. e Silva et al 34. Kim TH, Hwang SO, Cha YS, et al. The utility of noninvasive nasal positive pressure ventilators for optimizing oxygenation during rapid sequence intubation. Am J Emerg Med. 2016;34:1627-1630. 35. Sakles JC, Mosier JM, Patanwala AE, et al. First pass success without hypoxemia is increased with the use of apneic oxygenation during rapid sequence intubation in the emergency department. Acad Emerg Med. 2016;23:703-710. 36. Sakles JC, Mosier JM, Patanwala AE, et al. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med. 2016;11:983-992. 37. Doyle AJ, Stolady D, Mariyaselvam M, et al. Preoxygenation and apneic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange for emergency intubation. J Crit Care. 2016;36:8-12. 38. Dyett JF, Moser MS, Tobin AE. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne. Anaesth Intensive Care. 2015;43:577-586. 39. Lau J, Ioannidis JPA, Terrin N, et al. The case of the misleading funnel plot. BMJ. 2006;333:597-600. 40. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42:1336-1349. 41. Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med. 2012;60:749-754.e742.
Volume 70, no. 4 : October 2017
Figure 1. CT of the neck (axial view) showing a gas-forming abscess involving the right side of the neck (arrow). Figure 2. CTof the chest (axial view) showing a gas-forming abscess extending into the right anterosuperior mediastinum (arrow).
Figure 3. Swelling, redness, and left deviation of the trachea (arrow) just before cervicotomy.
Figure 4. Contrast-enhanced CT of the neck and chest (coronal view) showing resolution of the abscess, with persistent thrombosis of the right internal jugular vein (arrow) on postoperative day 38.
[Ann Emerg Med. 2017;70:463.] A 45-year-old man with a history of odontalgia presented to our hospital because of fever, dysphagia, dyspnea, hoarse voice, and right-sided neck pain for 4 days. The physical examination revealed a temperature of 39.4 C (102.9 F) and right-sided neck swelling, redness, and stiffness. Laboratory testing revealed a WBC count of 22.9109/L. Ultrasonography of the neck was suspicious for thrombosis of the right internal jugular vein. Computed tomography (CT) of the neck and chest showed abscesses involving the right side of the neck and the anterosuperior mediastinum (Figures 1 and 2). For the diagnosis and teaching points, see page 494. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 70, no. 4 : October 2017
Annals of Emergency Medicine 463
Effectiveness of Apneic Oxygenation During Intubation 27. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877-1887. 28. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574-583. 29. Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med. 2016;193:273-280. 30. Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care. 2016;61: 1160-1167. 31. Vourc’h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41: 1538-1548. 32. Fogg T, Alkhouri H, Vassiliadis J. The Royal North Shore Hospital Emergency Department airway registry: closing the audit loop. Emerg Med Australas. 2016;28:27-33. 33. Grant S, Khan F, Keijzers G, et al. Ventilator-assisted preoxygenation: protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emerg Med Australas. 2016;28:67-72.
494 Annals of Emergency Medicine
Oliveira J. e Silva et al 34. Kim TH, Hwang SO, Cha YS, et al. The utility of noninvasive nasal positive pressure ventilators for optimizing oxygenation during rapid sequence intubation. Am J Emerg Med. 2016;34:1627-1630. 35. Sakles JC, Mosier JM, Patanwala AE, et al. First pass success without hypoxemia is increased with the use of apneic oxygenation during rapid sequence intubation in the emergency department. Acad Emerg Med. 2016;23:703-710. 36. Sakles JC, Mosier JM, Patanwala AE, et al. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med. 2016;11:983-992. 37. Doyle AJ, Stolady D, Mariyaselvam M, et al. Preoxygenation and apneic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange for emergency intubation. J Crit Care. 2016;36:8-12. 38. Dyett JF, Moser MS, Tobin AE. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne. Anaesth Intensive Care. 2015;43:577-586. 39. Lau J, Ioannidis JPA, Terrin N, et al. The case of the misleading funnel plot. BMJ. 2006;333:597-600. 40. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42:1336-1349. 41. Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med. 2012;60:749-754.e742.
Volume 70, no. 4 : October 2017