Inspiratory Stridor and Diaphoresis Spell Emergency

​My relief had arrived, and we were just starting sign-outs. The resident broke in, "This guy with the sore throat. I think he's sick!" Glancing up from the computer, she continued. "He's barely talking. He has inspiratory stridor. And he is sweaty."​The resident had me at inspiratory stridor. Diaphoresis on a chilly morning in our ED was just icing on the cake. Intrigued and concerned (we did not have ENT or an open OR at that time in our shop), I followed my oncoming colleague to the bedside. The experience was just as sphincter-tightening as the description. The 20ish-year-old man sitting bolt upright and holding on to the bed rails could not even count to one. The back of his throat was normal, and the bedside soft tissue lateral neck radiograph provided no reassurance.Decision: immediate intubation. This was going to be tough. Few airways get tougher than this. All hands on deck (anesthesia, surgery, respiratory, CCU). All resources readied, including a scalpel and bougie.The first look down was disorientingly frightening. It looked like a cervix. The swollen epiglottis and aryepiglottic folds allowed only a tiny opening still available for plastic to pass. With amazing skill, luck, and perhaps some prayer, a 6.0 ET tube made it through that tiny passageway into the trachea.​The patient was whisked away to the CCU, and we had time to debrief and review. The patient's lateral neck image was placed beside a normal one on the computer screen.Th...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs