I’ve been told many times, “You’re doing ENT, that’s great. Early Nights and Tennis. Easy life with no emergencies, right?”. I’ve also been asked many times, “Is there such thing as an ENT emergency?”
Well, let me list some of the emergencies I’ve personally been involved with over the last few years. When I’m oncall for 10 days straight over the Christmas & New Year period, these are the emergencies that I will meet at odd hours of the night.
· Post operative tonsillectomy bleed: a bleed from a branch of the high-pressure external carotid artery into the oral cavity and airway, meaning one can exsanguinate to death in 5 minutes. Picture those horror movies where blood pours out of the nose and mouth. I have had to put my hand in a girl’s mouth and knelt over her body as we got wheeled into the operating room with full on resuscitation.
· Gunshot wound to the neck. Messy.
· Gunshot wound to the face. Bloody.
· Airway obstruction from an invasive thyroid cancer. Emergency awake tracheostomy performed through friable cancer mass. Death stands beside me while the patient in distress stares back at me as I cut her throat awake.
· Tooth abscess becoming a Ludwig’s angina, compartment syndrome of the floor of mouth. Mouth swollen, can’t be opened.
· Tongue cancer bleeding into the airway. Cannot intubate through cancer and bleeding tongue the size of cheeseburger in the mouth.
· Quinsy peritonsillar abscess becoming parapharyngeal abscess and disseminating rapidly inferiorly into the mediastinum. Death.
· Epiglottitis, cardiac arrest. Emergency specialist and anaesthetist cannot intubate cannot ventilate. Slash tracheostomy in 10 seconds.
· Massive epistaxis in a haemophilliac, or those on warfarin/Coumadin/aspirin/assasantin/dabegatran, or those with platelet disorders, or arteriovenous malformation.
· Facial trauma, midface degloving, massive bleeding from ears, noses, eyes, mouth.
· GCS 5, cerebral abscess and cerebral vein thrombosis from acute otitis media and suppurative mastoiditis.
· Arteriovenous malformation bleed from an erupted tooth requiring maxillectomy.
· Airway burns from house fire.
· 10month old child swallowing an opened safety pin, lodged in the larynx next to the carotid arteries.
· 11month old swallowing Christmas ornament, lodged in mid oesophagus.
· 12month old child swallowing a button battery, resulting in perforation of the trachea and oesophagus.
· Fishbone lodged in the larynx.
· Lamb bone perforating the oesophagus.
· Epistaxis from a nasopharyngeal carcinoma, out through the nose, and down into the airway.
· Lego piece inhaled into the lung.
· Denture with metal hooks swallowed and lodged between the larynx and oesophagus.
· GCS7, meningitis due to frontal sinus abscess penetrating into the brain.
· Eye abscess secondary to bacterial sinusitis. A young lady was blind in 12 hours from a misdiagnosed sinusitis.
· Acid and alkali ingestion causing airway chemical meltdown.
· Nasal septal abscess causing bilateral cavernous sinus thrombosis, blindness and death.
· Carotid artery blowout due to erosion from neck cancer.
· Relapsing polychondritis and Wagener’s granulomatosis causing cricoid airway obstruction.
· Kids developing abscesses behind the eye from a bacterial complication of the common cold.
· Acute mastoiditis from ear infections in young kids, causing facial paralysis and brain abscess.
· Meningitis and CSF leak from a nasal cancer invading into the brain through the cribiform plate.
· Retropharyngeal abscess in young kids, causing stiff neck and airway compromise with pus into the airway.
· Invasive fungal sinusitis/mucormycosis in chemotherapy, transplant and immunosuppressed patients, causing fungal invasion into brain and eyes.
· Airway obstruction and suffocation in patients with laryngeal cancer.
· Clothesline injury/hanging injury causing laryngeal fracture and laryngo-tracheal separation.
· Neonate with airway obstruction from vascular ring, vocal cord paralysis, choanal atresia.
· Tracheostomy tube eroding into the arch of aorta.
· Jellybeans, lego, foam in noses that can possibly end up in the lungs.
· Infected branchial cysts and deep neck space abscess causing airway obstruction.
· Skullbase fractures, CSF leaks from ears and noses.
· Sudden deafness and dizziness from brainstem tumour.
· Airway obstruction from glandular fever.
· Paradoxical vocal cord movements from whooping cough causing airway obstruction.
· Neck and airway trauma.
· And many more.
Wishing you a safe Christmas and praying that none of you would ever need to greet a surgeon this season.