Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


Case 1

You are the attending Emergency Physician at a tertiary care facility, covering the Emergency Department (ED). A 55-year-old male patient presents to the ED with progressive dyspnea and weight loss over a 3-month period. He is otherwise known to have hypertension and diabetes and takes hydrochlorothiazide and metformin as his only medications. On arrival, he has significant stridor at rest, despite this his oxygen saturations are 98% on room air, he is afebrile, blood pressure 155/80. A computed tomography (CT) scan is performed which reveals a large compressive mass in his neck, arising from the thyroid, thought to represent a thyroid carcinoma. This mass is causing compression at the level of the glottis resulting in a 1 mm opening. Anesthesia and otolaryngology are consulted by the ED for assistance in planning surgical management. It is decided that the patient should undergo thyroidectomy, laryngectomy, and lymph node dissection. Given this anatomy, it is likely that face-mask ventilation (FMV), the use of extraglottic device (EGD), and tracheal intubation, including awake approach, will all be difficult. Furthermore, given the location of the tumor, front-of-neck airway (FONA) access under local anesthesia is excluded as an option. You consult your local cardiac surgeon about the possibility of initiating extracorporeal membrane oxygenation (ECMO) in the awake state, as a primary means of airway management.

Case 2

A 34-year-old female who is 3 weeks postpartum presents to the ED with progressive shortness of breath and weakness and chest pain. She appears unwell, with slight reduction in mentation, HR 115, BP 70/50, O2 saturations 93% on 4 L·min−1 oxygen through nasal prongs (NP), with mild increase in work of breathing. Her skin is cold to touch, and she is making scant urine output. Laboratory results reveal an acute kidney injury, elevated troponin, and a lactate of 5.0 mmol·L−1. ECG reveals a sinus rhythm tachycardia. Bedside ultrasound shows biventricular failure with presence of b-lines suggestive of pulmonary edema. She is diagnosed with cardiogenic shock on the presumed basis of postpartum cardiomyopathy. Resuscitation is initiated with high-flow nasal oxygenation, vasopressors, and inotropes. Unfortunately, there is no improvement in end-organ perfusion. You identify some decline in her oxygenation but that is currently being adequately managed noninvasively. You wonder if this young patient would be a candidate for venoarterial ECMO (VA-ECMO) for cardiac support. However, you are unsure if the patient requires intubation for such an intervention. Your concerns about tracheal intubation of this patient include the potential for decompensation during induction and complications of mechanical ventilation.

Case 3

A 64-year-old male collapses at a local museum shortly after complaining to his partner about chest pain. Emergency Medical Services (EMS) called and bystander cardiopulmonary resuscitation (CPR) is initiated. An automated external defibrillator (AED) is available immediately, and on initial analysis recommends and delivers a shock. ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.