Violent, Intoxicated, then Suddenly Pulseless

DIAGNOSIS: Hypoxic arrest secondary to airway obstruction with peripheral intravenous (IV) catheter and dressing. Afterward, the assaulted medic reported that prior to being struck, she had witnessed the patient pull out his peripheral IV en masse and shove it in his mouth. Computed tomography scan of the facial bones did verify two mandible fractures, and we surmise that resultant impaired tongue control, neck immobilization from his cervical collar, and gasping during the struggle all contributed to inadvertent aspiration of the IV dressing.  The patient was admitted to an ICU, and incurred no neurologic sequelae from his cardiac arrest. To our knowledge, airway obstruction with peripheral IV equipment has not been previously reported in the medical literature. This case highlights the importance of close supervision and repeated assessment of intoxicated patients in the ED.