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    Feb 2010

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    Default Difficult Airways

    Has anyone ever had a patient that just could not be intubated?

    I work as a critical care nurse on a rapid response team in a large medical center. I had a patient a few months ago that had a hx of head and neck CA with a old tracheal stent that was 70% occluded by tumor regrowth. We called anethesia and told them to bring all of their back-up airway plans. He was in hypercapnic respiratory failure with a pH of 7.12 and CO2 of 125 and he had expressed 4 hours ago that he wants EVERYTHING done. An attempt was made to visualize the cords with a glidescope but he was not sedated enough. We could not start sedation because then we could lose the 30% airway that we do have if we were unable to intubate (the tumor was at the level of the vocal cords). We ended up going to the OR, anesthesia used sevo via mask. The CT surgeon used a flexible bronchoscope and was still unable to visualize due to swelling and secretions and his oxygen reserves were depleted and he began to desat. He couldn't be trached because of the stent. In the end, his family decided to make him DNR. I asked the anesthesia team if they have ever had a more difficult airway and they said it was one of the most difficult.

    It was one of my most memorable RRT cases and I really got to see how the critical airway decisions are made. Has anyone had a case that was this bad? If so, did you succeed in the end?
    Last edited by deemo21; 12-02-2011 at 11:39 PM. Reason: Grammar

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