Abstract
Background
Emergency intubation in a patient with advanced ankylosing spondylitis (AS) who presents
with severe thoracic kyphosis deformity, rigid cervical flexion deformity of the neck,
and an inability to achieve the supine position is particularly challenging to emergency
physicians.
Case Report
This study reports on an AS patient presenting with these difficult airway characteristics
and acute respiratory failure who was successfully intubated using video laryngoscope-assisted
inverse intubation (II) and blind digital intubation (BDI). By using Pentax AirwayScope-assisted
inverse intubation, the tracheal tube tip was passed through the glottic opening,
but an unexpected resistance occurred during tube advancement, which was overcome
by subsequent BDI. By using laryngoscope-assisted II complemented by the BDI technique,
the patient was successfully intubated without complications.
Why Should an Emergency Physician Be Aware of This?
Our case demonstrated that these two emergency airway management techniques are valuable
backup methods and complement each other when applied to certain unstable airways,
especially when the traditional patient position is not easily accomplished. Unexpected
difficulty is not rare during airway management; emergency physicians should always
be well prepared both mentally and practically.
Keywords
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Article info
Publication history
Published online: March 26, 2018
Accepted:
February 6,
2018
Received in revised form:
January 24,
2018
Received:
November 30,
2017
Footnotes
Streaming video: A brief real-time video clip that accompanies this article is available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
