Impending Carotid Blowout Stabilization Using an LT-D Tube

Adequate stabilization of a patient presenting with a carotid blowout is one of the most challenging issues an on-call ENT surgeon can be confronted with. Reducing the bleeding and securing the airway are essential before more definitive management. We present the case of a 72-year-old patient with head and neck cancer who arrived at the emergency room with a carotid blowout and who was successfully stabilized using a King LT-D ventilation tube. 1. Introduction Carotid blowout (CB) represents one of the most challenging problems for those caring for patients with head and neck cancer. While the literature in English over the last decade offers an abundance of articles on the endovascular treatment of CB, little is written about the initial stabilization of the patient. Patient stabilization is, however, essential prior to any further attempt at definitive treatment. 2. Case Report We present a case of impending CB successfully stabilized and eventually treated by using a King LT-D ventilation tube. The 72-year-old patient had sustained a sudden and massive bleed from the mouth at home. He was able to call the emergency services and was taken immediately by ambulance to our tertiary hospital emergency room. Paramedics were able to gain venous access but were not able to intubate the patient due to severe trismus. Baseline measures on admission were heart rate: 90/min, blood pressure: 91/67？mmHg, respiratory rate: 19/min, and SpO2: 96%. Physical examination revealed slow but active bleeding and large blood clots within the oral cavity. Flexible endoscopy revealed a huge clot within the oropharynx almost obstructing the airway. Only a small passage through this clot allowed the patient to breathe. Any attempt to remove the clot was followed by an increase in the active bleeding. The patient was unable to communicate, but the medical record revealed a history of recent neck recurrence (classified T0N3M0) of a base of tongue squamous cell carcinoma classified pT1pN1？M0 initially treated by glossectomy and unilateral neck dissection followed by external radiotherapy. The recurrence had been treated with concomitant chemoradiotherapy four months earlier. A neck CT Scan performed one month earlier had shown local recurrence with tumor necrosis and carotid artery involvement. No complimentary procedure had been proposed to the patient. Shortly after admission the patient’s respiratory distress and oral bleeding increased and the decision was made to stabilize the patient by endotracheal intubation and subsequent packing of the oropharynx. Three attempts to