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Tension Pneumothorax and Contralateral Presumed Pneumothorax From Endobronchial Intubation via Cricothyroidotomy*

Milo Engoren, MD, FCCP; Paul de St. Victor, MD
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*From the Departments of Anesthesiology and Internal Medicine (Dr. Engoren) and the Department of Emergency Medicine (Dr. de St. Victor), St. Vincent Mercy Medical Center, Toledo, OH.

Correspondence to: Milo Engoren, MD, FCCP, Departments of Anesthesiology and Internal Medicine, St. Vincent Mercy Medical Center, 2213 Cherry St., Toledo, OH 43608; e-mail: engoren@pol.net



Chest. 2000;118(6):1833-1835. doi:10.1378/chest.118.6.1833
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Cricothyroidotomy can be a life-saving procedure for the “can’t intubate, can’t ventilate” patient who has upper-airway obstruction. The procedure is usually fast and easy to do; however, complications have been reported. We report two cases in which cricothyroidotomy with an endotracheal tube led to unrecognized endobronchial intubation, ipsilateral tension pneumothorax, contralateral presumed pneumothorax, and unnecessary emergency surgery. Additionally, these led to the triad of hypotension, hypoxemia, and, probably, elevated intracranial pressure, which can worsen cerebral injury. We discuss methods to avoid these complications.

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