SAQ 2014 – Dysphagia, stridor and emergency airway planning

A 48-year-old man presents to a regional ED with 24 hours of dysphagia and fever, then develops new respiratory distress.

He is sitting upright, refuses to lie back, has difficulty swallowing secretions, mild stridor and a hoarse voice. Observations are BP 140/80 mmHg, HR 90/min, SpO2 99% on room air, temperature 37.8 C and RR 24/min.

The nearest tertiary centre is two hours by road. His lateral neck x-ray is shown below.

Twenty minutes later he develops worsening stridor and distress, becomes agitated and desaturates. You decide to intubate in ED; no anaesthetist is available.

State the likely diagnosis and the relevant positive radiographic finding.

(Marked out of 2.0)

/ 2

State the most common causative organism.

(Marked out of 1.0)

/ 1

State an appropriate antimicrobial choice.

(Marked out of 1.0)

/ 1

Complete the table of intubation issues and how you will address each.

(Marked out of 8.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Issue</th> <th>Approach</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 8

Total Score: 0 / 12

Percentage: 0%