Management of catastrophic haemorrhage in palliative head and neck cancer: creation of a new protocol using simulation.

Catastrophic haemorrhage or carotid blowout a rare but devastating consequence of head and neck cancer. In most cases, this represents a terminal event, and the patient is prescribed pre-emptive analgesia and anxiolytics. There is anecdotal evidence that due to the time taken to prepare the medications that patients do not receive these drugs prior to death. We aimed to identify the drug to patient time using simulated catastrophic haemorrhage simulations. We used the current protocol for this and also proposed a new grab-bag with preprepared anxiolytic and anagelsic medications. Each scenario was repeated 16 times. The mean time for drug administration using the current policy was 124 s compared with 48 s when the grab-bag was used (p<0.01). The new protocol also reduced the variability in the drug to patient time. We aim to implement this new protocol on the head and neck ward.

A frog in my throat doctor, well perhaps a tadpole? An interesting case of a laryngeal arteriovenous malformation.

We present an interesting case of a woman presenting with globus symptoms. Following an assessment, the patient was identified as having a strange pedunculated lesion originating from the laryngeal surface of the epiglottis. Following formal surgical excision, this lesion was identified as an arteriovenous malformation.