Abstrakt

Four days after admission because of a reoccurring stroke an 81-year-old male developed perpetuated respiratory insufficiency (S_pO₂ 72%, F_iO₂ 1,0) with somnolence in spite of non-invasive ventilation. The patient was presented to the anesthesiologist on call with basal coarse crackles. After transfer to the intensive care unit the arterial blood gas analysis showed global respiratory insufficiency (paO₂ 75 mmHg; paCO₂ 100 mmHg). Also, the patient suffered from tachycardia (160/minute) and hypertension (150/90 mmHg). During the physical examination no breath sounds could be auscultated over the right basal lung. An atelectasis (DD pneumothorax) was suspected and deep tracheal suction was performed, during which a rolled up cotton pad was recovered. The condition of the patient improved immediately after extraction of the cotton pad as far as the oxygen saturation during pulse oximetry as well as the corresponding blood gas analysis (paO₂ 92 mmHg; paCO₂ 45 mmHg) was concerned. The question remained how the bolus aspiration occurred. During closer examination a fragrance could be identified on the cotton pad. It became apparent, that the patient often inserted a cotton pad with essential oil into his nose when he had difficulties of breathing. The aspiration must have happened during the stroke. Difficulties of breathing of all patients must be taken seriously and aspiration as well as bolus aspiration as differential diagnosis must always be taken into consideration.

Autoreninformation

Autoren

• M. Umstätter
• S. Piper

Abteilungen

• Stadtklinik Frankenthal, Fachbereich Anästhesie und Intensivmedizin

Adresse

Dr. Marianne Umstätter
Stadtklinik Frankenthal
Anästhesie und Intensivmedizin
Elsa-Brändströmstraße 1
D–67227 Frankenthal
Email: [email protected]

Citation