Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Senhora da Hora, Portugal.
J Emerg Med. 2024 Feb;66(2):133-138. doi: 10.1016/j.jemermed.2023.10.023. Epub 2023 Oct 30.
Bleeding in the upper airways is an important cause of airway-related death. A higher incidence of airway management failure and complications after intubation attempts in the emergency department (ED) had been suggested. Airway management of patients with active oropharyngeal hemorrhage may be challenging, leading the clinician to modify the approach.
A 57-year-old woman presented to the ED with oropharyngeal hemorrhage after an extensive invasive dental procedure. She was on long-term warfarin therapy due to aortic and mitral valve replacement, which she suspended 5 days prior and restarted the day after the procedure. Besides the active bleeding, swelling, and hematoma of the face, the patient had other signs of "difficult airway," so there were serious questions on when and how to manage the airway. Several strategies to address the airway were considered, the main point being an early versus later intubation. As the patient remained clinically stable, she was conservatively managed with local hemostasis and coagulopathy reversal. The patient was transferred to the intensive care unit, where she remained stable and was successfully discharged after restart on warfarin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When faced with an oropharyngeal hemorrhage, emergency physicians may be compelled to secure and protect the airway. This could be achieved by planning several strategies. Nevertheless, in selected patients, and considering the circumstances, not addressing the airway is a reasonable and justifiable alternative.
上呼吸道出血是导致气道相关死亡的一个重要原因。有研究提示，在急诊科（ED）进行插管尝试后，气道管理失败和并发症的发生率更高。处理有活动性口咽出血的患者的气道可能具有挑战性，这可能导致临床医生修改处理方法。
一名 57 岁女性在接受广泛的侵袭性牙科手术后出现口咽出血，被收入 ED。她因主动脉瓣和二尖瓣置换术而长期服用华法林，在该手术前 5 天停药，并在手术后的第二天重新开始服用。除了活动性出血、面部肿胀和血肿外，该患者还有其他“困难气道”的迹象，因此对何时以及如何处理气道存在严重疑问。考虑了几种处理气道的策略，主要问题是早期还是晚期插管。由于患者临床状况稳定，对其进行了局部止血和凝血功能障碍逆转的保守治疗。患者被转至重症监护病房，在那里她保持稳定，并在重新开始使用华法林后成功出院。
为什么急诊医生应该了解这一点？：当面对口咽出血时，急诊医生可能会被迫保护气道。这可以通过制定几种策略来实现。然而，在某些特定患者和具体情况下，不处理气道是合理和正当的替代方案。
