WWWTP #14 Answer….

February 25, 2014

WWWTP


What’s Wrong With This Picture #14 Answer:

WWWTP 14

This elderly woman developed sudden shortness of breath and then had a hypoxic bradycardic cardiac arrest. Based on decreased breath sounds on the left and lack of lung sliding on ultrasound, she was needle decompressed (hence the subcutaneous air).  She was subsequently intubated.  A left subclavian central line was attempted since that was the side that was going to ultimately get a chest tube. Venous return was obtained, the wire passed smoothly, and once the line was in, blood was backing up in a pulsatile manner, suggesting arterial placement. It was left in place to tamponade the site.   This CXR confirmed arterial placement of the left sided line as it passes into the left side of the mediastinum at the aortic arch.

Here’s a short article on vascular repair of a SCA line placement:
http://www.hindawi.com/crim/vascular.medicine/2012/150343/

 Author:  Vivienne Ng, MD
 
Thanks go to Dr. Ng for the image and above discussion!
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