Book review
https://doi.org/10.20471/acc.2023.62.s1.22
Emergency Tracheotomy in Tracheal Stenosis – A Case Report
Mia Hajnal
; Department of Emergency Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
Antonija Mišković
; Ear, Nose and Throat Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
Anto Lukenda
; Department of Emergency Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia; Department of Surgery, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
Ivana Pajić Matić
; Ear, Nose and Throat Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
Abstract
Airway management in an emergency department is the first step in critical care of
an urgent patient. When orotracheal intubation is not possible due to upper airway obstruction, such
an emergency is known as a ‘cannot intubate – cannot ventilate’ situation. Then, emergency tracheotomy
is indicated. We present a case of a 70-year-old patient complaining of progressive dyspnea. The
patient was conscious, highly tachydyspneic, and tachycardic. Loud stridor and a scar from previous
tracheostomy suggested upper airway obstruction. Patient history confirmed previous partial laryngectomy
and temporary tracheostomy due to laryngeal cancer 10 months before. Differential diagnosis
of tracheal stenosis was set, and an ENT specialist was requested. Flexible fiberoptic laryngoscopy
demonstrated a 1-mm subglottic tracheal stenosis. Emergency surgical tracheotomy below the obstruction
in awake state using local anesthesia was performed to secure the airway. Early postoperative
care was complicated by incipient right-sided pneumonia, which may have provoked narrowing of the
existing subglottic stenosis in the first place. Tracheal stenosis is an important differential diagnosis
of airway obstruction in patients with previous malignant diseases of the upper respiratory system.
Emergency physicians should promptly recognize these situations based on clinical examination to
secure appropriate airway management.
Keywords
Emergency medicine; Tracheal stenosis; Tracheotomy; Respiratory sounds; Airway obstruction
Hrčak ID:
307565
URI
Publication date:
1.4.2023.
Visits: 290 *