Emergency Cricothyrotomy in a 51-Year-Old Woman with Traumatic Airway Obstruction After a High-Speed Collision.

Abstract

BACKGROUND Emergency airway management in trauma patients can be challenging. Injuries to the neck that cause fractures, deformities, gross hemorrhage, burns, and edema can complicate normal endotracheal intubation. This reported case is of a patient presenting with acute traumatic airway obstruction, requiring an emergency cricothyrotomy. CASE REPORT We present the case of a 51-year-old woman involved in a high-speed rollover collision presenting with altered mental status, numerous facial fractures, and large distorting anterior neck masses. Shortly after the patient's arrival at the Emergency Department, her mental status acutely deteriorated and necessitated the need for establishment of a definitive airway. Rapid sequence endotracheal intubation was attempted by the emergency and anesthesia teams using manual and video laryngoscopy techniques, but appropriate visualization of anatomical landmarks was unsuccessful. An attempt at passing an Eschmann-style bougie tracheal tube introducer was also unsuccessful, due to significant airway edema. As a last resort, an emergency cricothyrotomy was performed. During the procedure, the operator noted a distorted anatomy of the anterior neck, with a large left neck mass pushing the larynx away from the typical midline position toward the right side of the patient's neck. CONCLUSIONS This report aims to highlight the importance of airway evaluation in patients with acute trauma and has shown that cricothyrotomy is a life-saving procedure. This case report further emphasizes a need for flexibility by the trauma team to have contingencies ready for atypical presentations in which standard airway measures prove difficult to employ.