Indian Journal of Palliative Care
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Table of Contents 
IMAGES IN PALLIATIVE MEDICINE
Year : 2013  |  Volume : 19  |  Issue : 2  |  Page : 119

Type 2 (impending) carotid blow out syndrome


Department of Integrative Oncology, Health Care Global Bangalore Institute of Oncology, Bangalore, Karnataka, India

Date of Web Publication21-Aug-2013

Correspondence Address:
Naveen Salins
Department of Integrative Oncology, Health Care Global Bangalore Institute of Oncology, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.116708

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How to cite this article:
Salins N, Omkarappa LS. Type 2 (impending) carotid blow out syndrome. Indian J Palliat Care 2013;19:119

How to cite this URL:
Salins N, Omkarappa LS. Type 2 (impending) carotid blow out syndrome. Indian J Palliat Care [serial online] 2013 [cited 2020 Aug 12];19:119. Available from: http://www.jpalliativecare.com/text.asp?2013/19/2/119/116708


A 41-year-old male, a known case of metastatic neck nodal disease with unknown primary presented to palliative care outpatients with neck pain, deep seated neck ulcer and bleeding from the neck ulcer. Clinical examination revealed a wide, infected, foul smelling, necrotic ulcer extending from the nape of the neck posteriorly to the midline anteriorly. On deeper examination of the ulcer, there was continuous serosangious discharge, with minimal frank bleeding over the exposed carotids. Two satellite fungating wounds were noted over the right occiput and right clavicle [Figure 1]. Patient was managed conservatively with local hemostatic (Hemocoagulase) and Metronidazole dressing, systemic anaerobic cover and oral Tranexamic acid. Selective COX II inhibitor (Etorocoxib) and Tapentadol were used as analgesics. Family members were counseled about possible massive hemorrhage and educated about managing the crisis at home with simple interventions. Endovascular stenting and surgical interventions were deferred in view of advanced nature of the disease and poor socio-economic status.
Figure 1: Type 2 CBS image

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Carotid blow out syndrome (CBS) is common in patients with head and neck cancer and infection, fungating tumors, surgery, and radiotherapy are common risk factors. CBS is classified into three types. Type 1 (Threatened CBS) occurs when carotid artery is exposed due to soft tissue breakdown. Type 2 (Impending CBS) occurs when exposed carotid artery has limited sentinel bleeding and Type 3 (Active CBS) occurs when there is active hemorrhage or carotid rupture.

In a palliative care setting patients with Type 1 and 2, CBS should receive an emergency care plan which should include dark colored linens/towels to cover and absorb blood (less distressing than seeing bright red blood on white linens); gloves, face/eye protection (in case of brisk arterial spraying), and other universal precautions. Suctioning equipment for clearing the mouth or tracheostomy of blood is desirable. Midazolam 5-10 mg intravenous (IV) can be given as a single shot if the patient has severe dyspnea or restlessness. The family should be counseled and educated about emergency planning and accessing help.


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