How would you manage this case?

[cockblockandrun]

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How could the airway be secured in this situation?

 

[Intrathecal]

Awake FOB or awake tracheostomy done by surgeon. 4% nebulized lido, attempt to find landmarks for airway nerve blocks (greater and lesser cornu of hyoid bone), trantracheal injection. Usually 4% nebulized lido is adequate and don't need the airway blocks. If too bloody when going in with scope, suction a few times, and see if you get lucky. If not, let the surgeon do his thing.

 

[Bertelman]

Superb way to merge a clinical discussion with sports. You have appeased all the Debbie Downers here that cry for the dearth of relevant topics, while appealing to all the others that get enough of that crap at work.

Heck, you've even provided an excuse for those that will be surfing SDN in the OR- "No, really, Dr. Chief Anesthesiologist, I'm learning how to manage an emergent difficult airway! I only read ESPN for the clinical pearls!!!"

Bravo.

 

[Jeff05]

awake tracheostomy by ENT.
when i see extensive crush injuries to the larynx, that's the way to go. i have actually never seen extensive crush injuries to the larynx, but that would be my approach.

i would not do an awake FO, as making this guy cough during topicalization would not be great for his compromised larynx.

whatever happens, this guy cannot go to sleep without a secure airway.

 

[urge]

Awake trach. In fact, so awake that it can be done in the ER without anesthesia.

 

[monchi]

Feel bad for the dude, but that is an awesome case. Thank you.

 

[Noyac]

Yep, there is more need to screw around here with anything but a trach. I wonder if he got his trach b/4 leaving the weight room.

 

[urge]

that is an awesome case.

Maybe for the ent residents, not anesthesia. Seriously, what is great about it?