Critical Care and Shock

Respiratory Distress in an Elderly – Delayed Presentation of an Odontoid Fracture

An 85-year-old man with history of severe dementia lay down for a nap and was witnessed by his family to immediately lose consciousness, with agonal breathing. He was ventilated by facemask by the paramedics when they attended. His vital signs were stable. On admission to hospital he grimaced to painful stimulus only (Glasgow Coma Score=6/15). His arterial blood gas revealed – pH 7.21, pCO2 70 mmHg and bicarbonate 27 mmol/L. He was intubated.
The patient had a fall 1 week before. He had complained of intermittent headache and neck pain since then. He also developed new symptoms of breathlessness upon lying flat. Computed tomography (CT) of cranium and neck was done. Figure 1 and 2 showed a fracture through the base of the odontoid (type II). Figure 3 showed prevertebral soft tissue swelling associated with the fracture. After discussion with the family, he was treated conservatively with a cervical collar in view of his advanced age and dementia.

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