Emergency Cases Northwest Group

038 Both Hands Full

Situation

Man fell, fractured his hyoid bone, later developed partial airway obstruction.

Background

A 55 year old man was carrying a cup to tea in each hand in the bedroom. He tripped, fell landing on the anterior part of his neck on the wooden bed frame. Came by ambulance to the ED. CT neck showed hyoid bone fracture only. Because he complained bitterly of bilateral neuropathic pain in both arms referred orthopaedics for further imaging of the neck. During the night developed stridor and needed steroids, adrenaline nebs. MRI later showed no neck fracture but significant oedema around the hyoid fracture and airway narrowing.

Assessment

The significance of the hyoid fracture was not appreciated at the time. That there were no airway issues at presentation was falsely reassuring.

Recommendation

If the patient has a hyoid fracture be aware that airway compromise may develop hours later.

In these fractures do refer to ENT as soon as possible [+- anaesthetics if there is an immediate airway problem].

But also discuss with critical care to see if the patient needs observing in HDU rather than a normal ward [this is even in the absence of airway compromise as these can develop later].



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group