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Case Reports
. 2023 Apr;62(Suppl1):160-164.
doi: 10.20471/acc.2023.62.s1.22.

EMERGENCY TRACHEOTOMY IN TRACHEAL STENOSIS - A CASE REPORT

Mia Hajnal  1 , Antonija Mišković  2 , Anto Lukenda  1   3 , Ivana Pajić Matić  2
Affiliations
Case Reports

EMERGENCY TRACHEOTOMY IN TRACHEAL STENOSIS - A CASE REPORT

Mia Hajnal et al. Acta Clin Croat. 2023 Apr.

Abstract

Airway management in an emergency department is the first step in critical care of an urgent patient. When orotracheal intubation is not possible due to upper airway obstruction, such an emergency is known as a 'cannot intubate - cannot ventilate' situation. Then, emergency tracheotomy is indicated. We present a case of a 70-year-old patient complaining of progressive dyspnea. The patient was conscious, highly tachydyspneic, and tachycardic. Loud stridor and a scar from previous tracheostomy suggested upper airway obstruction. Patient history confirmed previous partial laryngectomy and temporary tracheostomy due to laryngeal cancer 10 months before. Differential diagnosis of tracheal stenosis was set, and an ENT specialist was requested. Flexible fiberoptic laryngoscopy demonstrated a 1-mm subglottic tracheal stenosis. Emergency surgical tracheotomy below the obstruction in awake state using local anesthesia was performed to secure the airway. Early postoperative care was complicated by incipient right-sided pneumonia, which may have provoked narrowing of the existing subglottic stenosis in the first place. Tracheal stenosis is an important differential diagnosis of airway obstruction in patients with previous malignant diseases of the upper respiratory system. Emergency physicians should promptly recognize these situations based on clinical examination to secure appropriate airway management.

Keywords: Airway obstruction; Emergency medicine; Respiratory sounds; Tracheal stenosis; Tracheotomy.

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Figures

Fig. 1
Fig. 1
CT scan of the neck showing tracheal stenosis with a 3-mm diameter at the thyroid gland level.
See this image and copyright information in PMC

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