Muertes por Hemoaspiración en Costa Rica en el año 2015 / Deaths from Hemoaspiration in Costa Rica in 2015

Resumen:La aspiración de sangre en las vías respiratorias es un resultado frecuente de las autopsias en casos de trauma, este hallazgo se relaciona a fracturas de la base del cráneo con laceraciones de la naso y orofaringe.La hemorragia pulmonar aguda antes de la muerte puede aparecer como sangrado dentro del árbol bronquial y ocasionalmente proximal a la tráquea, debido a causas traumáticas o no traumáticas.En este estudio se reportan casos de hemoaspiración ocurridos en víctimas fallecidas, siendo un hallazgo forense frecuente, se contabilizaron 3148 víctimas fallecidas en el año 2015, se tomaron los casos que tenían evidencia en la autopsia de sangre en los pulmones y/o en las vías aéreas. Se obtuvo un total de 37 víctimas con dicho diagnóstico forense, con predominio en hombres entre los 21 y 30 años de edad y seguido por hombres entre los 31 y 40 años de edad. Se documentó una mayorincidencia en los meses de abril y diciembre los cuales coinciden con los meses festivos en Costa Rica y la causa de muerte predominante fue accidental, seguido por homicidio y suicidio.

Abstract:Airway blood aspiration is a frequent result in trauma patient autopsies; it's generally associated with skull base fractures with naso and oropharynx.Acute pulmonary hemorrhage prior to death can appear as bleeding in lower airways in traumatic and non-traumatic cases.Occasionally it can also appear in upper respiratory airways as well.In this study we evaluate blood aspiration in dead victims. A total of 3148 victims deceased in 2015, 37 had pulmonary or lower airway hemorrhage as a forensic diagnose, a higher incidence in males was found with ages between 21 and 30 years, followed by males between 31 and 40 years old. The peak incidence was in the months of April and December, which are months with a high amount of holidays in Costa Rica, the predominant cause of death was accidental, followed by homicide and suicide.

Aspiration of Blood from the Left Lung to the Right Lung and Hypoxemia during One-lung Ventilation Using Single-Lumen Endotracheal Tube / 대한마취과학회지

The leading cause of death of massive hemoptysis is the aspiration of blood into the contralateral normal lung resulting in asphyxia. The management of massive hemoptysis can be performed by the evacuation of the blood, and the protection and ventilation of the uninvolved lung from aspiration. Double-lumen endotracheal tubes provide lung isolation, the ability to ventilate one or both lungs, and suction in case of acute endobronchial hemorrhage. We report a case of blood aspiration and hypoxemia which occurred during one lung ventilation using single lumen endotracheal tube for left pneumonectomy. The patient was treated with a supplement of 100% oxygen, continual suctioning, and positive-pressure ventilation. If we had used a double-lumen endotrachal tube, it would have enabled us to separate both lungs, to clear the left lung, and to apply ventilatory support on the contralateral lung.

A case of blood aspiration due to epistaxis during nasotracheal intubation / 대한마취과학회지

Nasotracheal intubation is usually recommended when surgery in the oral cavity or on the mandible is facillitated by an unobstructed view. If the mouth is to be wired or banded shut after surgery, a nasal tube must be used. Contraindication to nasal intubation include coagulopathy, severe intranasal pathology, basal skull fracture, and presence of a cerebrospinal fluid leak. We experienced a case of blood aspiration during nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to mandible fracture. On preoperative evaluation, specific problem was not noted. During nasotracheal intubation, epistaxis was developed and the aspiration of blood into the lung was occurred, accidentally. Operation was postponed and the patient was transferred to recovery room. In recovery room, a chest x-ray of left lung revealed deerease of volume, increase of interstitial marking, and more opaque finding than right lung. Arterial blood gas revealed pH 7.43, PCO2 44mmHg, PO2 61mmHg. With frequent suction, encouraging expectoration, antibiotic therapy and 0, supplementation by nasal prong, patient was nearly normalized following 5 hours after the episode of aspiration. Carefully, retrial of nasotracheal intubation was done one week later under the preparation of bosmin (Jeil pharmacy) nasal packing and lubricated endotracheal tube. Intubation and the operation was finished uneventfully.