Abstract
Background
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.
Case Report
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.
Keywords
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Article info
Publication history
Published online: July 27, 2019
Accepted:
May 6,
2019
Received in revised form:
April 3,
2019
Received:
July 11,
2018
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
