Trivia Time! Fly Into The Danger Zone!

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The "Danger Space" in the neck is bounded by/indicated by which letter in the diagram above?

A.

The "danger space" is also known as the alar space. It is bounded by the alar fascia anteriorly and the prevertebral fascia posteriorly.

The 3 major spaces in the posterior pharyngeal soft tissues are (from posterior to anterior)

  1. Prevertebral Space
  2. Alar Space (Danger Space
  3. Retropharyngeal Space

Reference

  1. Jaworsky D, Reynolds S, Chow AW. Extracranial head and neck infections. Crit Care Clin. 2013 Jul;29(3):443-63. doi: 10.1016/j.ccc.2013.03.003.

Why is it called the "Danger Space"

The alar space aka "danger space" is begins at the skull base and extends inferiorly to the diaphragm. Because of this infections that begin in the head and neck can extend into the mediastinum leading to descending necrotizing mediastinitis (which as you can probably judge by the name carries significant morbidity and mortality). As with retropharyngeal abscesses and infections, danger space infections can lead to significant larygneal inflammation and airway compromise.

Reference

  1. Jaworsky D, Reynolds S, Chow AW. Extracranial head and neck infections. Crit Care Clin. 2013 Jul;29(3):443-63. doi: 10.1016/j.ccc.2013.03.003.

Some tracheostomy tubes are “fenestrated,” what does fenestration mean in the original Latin?

Fenestration derived from the Latin fenestrare from fenestra meaning "window, opening for light"

Reference

  1. fenestration. (n.d.). Online Etymology Dictionary. Retrieved August 24, 2017 from Dictionary.com website http://www.dictionary.com/browse/fenestration

What 2 factors make cricothyrotomy with a ballpoint pen infeasible?

A cricothyrotomy using only a ballpoint pen is virtually impossible due to the strength of the cricothyroid ligament. In a study using fresh cadavers, only 1 out 10 medical laypersons were able to successfully penetrate the cricothyroid membrane "with a lot of patience and force." (1)

One could clearly use a pocket knife or other sharp implement to first incise the skin and cricothyoid ligament. However, the vast majority of commercially available ballpoint pens have a tiny internal diamter leading to excessive airflow resistance. A 2010 study in the Emergency Medicine Journal (2) found only 2 pens available at that time suitable to serve as an improvised tracheostomy tube - the BIC soft feel jumbo and the Baron retractable ballpoint pen.

References

  1. Kisser U, Braun C, Huber A, Stelter K. Bystander cricothyrotomy with ballpoint pen: a fresh cadaveric feasibility study. Emerg Med J. 2016 Aug;33(8):553-6. doi: 10.1136/emermed-2015-205659. Epub 2016 Apr 19.
  2. Owens D, Greenwood B, Galley A, Tomkinson A, Woolley S. Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy. Emerg Med J. 2010 Apr;27(4):317-20. doi: 10.1136/emj.2008.069294.