Department of Emergency Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.
Ear, Nose and Throat Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.
Acta Clin Croat. 2023 Apr;62(Suppl1):160-164. doi: 10.20471/acc.2023.62.s1.22.
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.
在急诊科进行气道管理是危重症患者急救的第一步。当由于上呼吸道阻塞而无法进行经口气管插管时，这种紧急情况被称为“无法插管-无法通气”情况。此时，需要紧急进行气管切开术。我们报告了一例 70 岁患者，主诉进行性呼吸困难。患者意识清楚，呼吸急促，心动过速。高调喘鸣和先前气管切开术的疤痕提示上呼吸道阻塞。患者病史证实了 10 个月前因喉癌行部分喉切除术和临时气管切开术。诊断为气管狭窄，并请耳鼻喉科专家会诊。纤维喉镜检查显示 1 毫米的声门下气管狭窄。在清醒状态下使用局部麻醉在阻塞下方进行紧急手术气管切开术以确保气道通畅。早期术后护理出现右侧肺炎初发，这可能首先引起了现有的声门下狭窄。气管狭窄是上呼吸道恶性肿瘤患者气道阻塞的重要鉴别诊断。急诊医生应根据临床检查及时识别这些情况，以确保进行适当的气道管理。
