To respond to some of the questions above:
I chose not to run back to the OR to get a fiberoptic because the neck and pharyngeal soft tissue were expanding as we watched. We don't have anesthesia techs in house to run for those things. Furthermore, an ER nurse or tech wouldn't know where to get them if I sent them for it. The Glidescope was immediately available, so I went with it. Our leading diagnosis was Boerhaave, with tracheal rupture a distant second. As for why I did not intubate on the first look, the patient was coughing some during the look, so I did not want to worsen the subq air with trying to pass the tube without paralytic. I probably could have done some topicalization, however at that moment my thoughts were #1: secure an airway and #2: get him to stop coughing and making the swelling worse, which paralyzing him did. I achieved the first look at the cords with minimal effort, so I was reasonably confident I could do so with a second look. As to
@tvelocity514, I gave him an induction dose of ketamine, so I was not concerned with recall with paralysis. All good comments, though!