What's Your Diagnosis? Emergency Department Management of Surgical Airway Complications

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Angioedema in the Emergency Department: An Evidence-Based Update correct.

Case Presentation: Emergency Department Management of Surgical Airway Complications

EMS brings in a 54-year-old man who has a swollen tongue and is in obvious respiratory distress…

He is tripoding with accessory muscle use, demonstrates conversational dyspnea, and is drooling. His vital signs are significant for hypoxemia that corrects with a nonrebreather mask, tachycardia, and hypertension.
You see on his medication list that he takes lisinopril, and you are concerned he has progressing angioedema, so you decide to intubate.
Using an awake, flexible video laryngoscopic approach, you visualize swelling extending beyond the base of his tongue, and you are unable to pass the endotracheal tube.
The patient’s swelling is getting worse, and he is now becoming hypoxic.
How will you secure a definitive airway on this patient?

Case Conclusion

It was clear that the patient would need an emergent cricothyrotomy. As you prepared for the procedure, the surgical team was called for backup. An emergent cricothyrotomy was successfully performed in the ED by the attending physician. The consult team was aware of the procedure but did not need to assist. When performing high-acuity, low-frequency procedures, involving surgical specialists early can mitigate potential complications should they arise and help ensure best patient outcomes.