gms | German Medical Science

Introduction: The case of an 85-year-old patient is reported. Under phenprocoumon (Falithrom^®) it probably came causeed by a dysfunction of the liver in the stage Child A to a relative overdosage. With extended hypertensive crisis the whole tongue body and oral ground showed a distinctive hematoma. The respiratory tract was constricted by the massive protrusion of the tongue and the swells.

Course: After admission to hospital the breath function got worse increasingly. With the blood-worth struck among other things a prothrombin time (Quick) of 3% with an international normalized ratio of 21.5 and a partial thromboplastin time of 111 sec. On account of this coagulation situation the fiber-optical intubation was aimed primarily. At the same time the preparation occurred to the emergency tracheotomy. After the first unsuccessful attempt the patient got in local anesthesia with spontaneous respiration and oxygen gift about mask (FiO2 1.0) the tracheotomy. The oxygen saturation always amounted to more than 88%. In consideration of the age and several accompanying illnesses it came only hesitantly to a weaning of the respirator. The come out tongue the spontaneous course was waited for the avoidance by necrosis locally cares under antibiotic screening. After approx. 8 days the tongue was again in the oral cavity. The tracheotomy tube was removed 24 days after tracheotomy. During the process a restitutio ad integrum occurred..

Conclusion: A fastest possible substitution of prothrombin complex concentrates (PCCs) forms the basis of a surgical intervention in the emergency room with life-menacing bleeding. The sudden correction of the coagulation system permits immediate operating and stands with it in the permissible relation to the raised risk of thrombotic embolism. A co-ordinated interdisciplinary teamwork with agreed structures in the emergency room is essential.