Endotracheal intubation (ETI) is used to effectively manage a patient’s airway. Failure of ETI may lead to ineffective ventilation or oxygenation, potentially causing organ damage and eventually death. Approximately 8% of ETIs are difficult and 1% are unsuccessful. Tools and techniques to successfully obtain airway access are essential.
A patient with chronic obstructive pulmonary disease presented to the emergency department in acute respiratory distress. Noninvasive positive pressure ventilation was unsuccessful in improving the patient’s tidal volume and work of breathing. The patient was unable to be intubated by conventional techniques because of a mass obstructing the view of her vocal cords. A cricothyrotomy was considered, but not initially performed because of her distorted anatomy. After multiple intubation attempts from several different physicians, the patient was successfully intubated with the aid of a suction Yankauer, which was used to move the mass peripherally and further served as a conduit through which a bougie was passed.
Why Should an Emergency Physician Be Aware of This?
The risk for complications rises with each intubation attempt. While there are a variety of tools and aids that can be used to assist in difficult intubations, rapid airway access is essential, and common tools do not always work. We hope that knowledge of this novel, yet simple and effective technique will help physicians successfully intubate patients with distorted oropharyngeal anatomy who cannot be intubated using conventional methods.
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- The difficult airway in the emergency department.Int J Emerg Med. 2008; 1: 107-111
- The first shot is often the best shot.Anesth Analg. 2015; 121: 1389-1393
- Tracheal intubation in the ICU: life saving or life threatening?.Indian J Anaesth. 2011; 55: 470-475
- Can an airway assessment score predict difficulty at intubation in the emergency department?.Emerg Med J. 2005; 22: 99-102
- Difficult intubation in thyroid surgery: myth or reality?.Anesth Analg. 2006; 103: 965-968
- Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique.Saudi J Anaesth. 2013; 7: 86-89
- Management of malignant tracheobronchial obstruction.Surg Clin North Am. 2002; 82: 621-642
- Smoking and cancer. Overviews of diseases/conditions, tips from former smokers.(Available at:)https://www.cdc.gov/tobacco/campaign/tips/diseases/cancer.htmlDate accessed: February 7, 2018
- What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?.Emerg Med J. 2013; 30: 888-892
- The importance of first pass success when performing orotracheal intubation in the emergency department.Acad Emerg Med. 2013; 20: 71-78
- Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.Br J Anaesth. 2015; 115: 827-848
- Suction tube-facilitated videolaryngoscopic intubation.Anaesthesia. 2015; 70: 1003
- Use of suction catheter as an aid to intubation in emergency situation of intraoral bleeding.Indian J Anaesth. 2010; 54: 267-268
- The bougie and first-pass success in the emergency department.Ann Emerg Med. 2017; 70: 473-478
Published online: July 27, 2019
Accepted: May 6, 2019
Received in revised form: April 3, 2019
Received: July 11, 2018
Reprints are not available from the authors.
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