Effect of fibrinolytic treatment in malignant atrophic papulosis.

(1) Excessive pharyngeal secretions irritating the vocal chords may have initiated laryngeal spasm and respiratory arrest, the consequent hypoxia in turn provoking cardiac arrest. When pharyngeal insufflation via a facemask is used in such circumstances air is delivered under pressure to both the vocal cord and the cricopharyngeal sphincter. The reflex activity of the glottis is greater than that of the cricopharyngeus, and therefore the air will simply pass through the cricopharyngeal sphincter and dilate the stomach. (2) Simple airway obstruction with hypoxia followed by cardiac arrest and attempts at forced ventilation would tend to distend the stomach. The chest was noted to inflate, however, and the patient's cyanosis and general condition improved, so that this explanation is unlikely. (3) Pharyngeal suction may have induced a "vagal reflex." This, however, would not specifically predispose to gastric distension and is thus unlikely.