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Chapter 26. Airway Management in a Patient with Angioedema

ACE-inhibitor-induced angioedema patients

A. usually respond to subcutaneous and aerosolized epinephrine

B. have an unpredictable clinical course with respect to the airway

C. can usually be safely observed as long as they do not have stridor

D. usually respond to high-dose intravenous steroids

E. can be managed with fresh frozen plasma

(B) In general, the clinical course of angioedema is unpredictable with respect to the airway.

All of the strategies for definitive airway management are acceptable in patients with angioedema EXCEPT

A. awake intubation using a flexible bronchoscope

B. awake intubation under direct laryngoscopy

C. rapid sequence intubation

D. cricothyrotomy

E. tracheotomy

(C) Bag-mask-ventilation, the use of extraglottic devices, and tracheal intubation under direct laryngoscopy are likely to be difficult in patients with angioedema. Therefore, tracheal intubation using RSI will be imprudent as this may result in a complete airway obstruction, limited effective airway options, and a CICO situation.

Which of the following symptoms would suggest a marginally patent airway that requires definitive airway management?

A. stridor

B. muffled voice

C. oxygen desaturation

D. difficulty managing secretions

E. use of accessory muscles

(A) Fixed laryngeal obstruction with stridor at rest implies a reduction in the caliber of the airway to 4.5 mm or less in diameter.

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