Case 14: The Stuck Elevator

Abstract

A 6-year-old girl falls out of a car (traveling 35 mph) onto her left side. She is taken to the hospital with C-spine precautions. On arrival, the patient is alert and oriented. The C-spine films are negative. The patient is hemodynamically stable in the emergency room without evidence of external injuries other than superficial abrasion. She has no long-bone fractures, and two peripheral (18-gauge) intravenous (IV) lines are inserted. Her hematocrit (Hct) is 30 %. Just as she is about to be discharged she complains of abdominal pain. An abdominal computed tomography (CT) scan reveals intraperitoneal fluid and a ruptured splenic capsule. The patient is scheduled for an emergency laparotomy and transported to the operating room with oxygen, 6 l per minute, breathing spontaneously with a mask airway. A Jackson Rees modification of the Ayres T-piece is used to provide oxygen. In the elevator, the patient complains of sudden onset of chest pain and difficulty in breathing.