Fiberoptic Nasotracheal Intubation in the Emergency Department for Severe Upper Airway Obstruction

Abstract

Angioedema of the upper airway can pose a challenge in emergency airway management. The semi-awake fiberoptic nasotracheal intubation is an uncommonly performed procedure that allows for the establishment of a definitive airway without removing the patient’s airway reflexes, protecting against the cannot intubate-cannot oxygenate scenario. Although common teaching in emergency medicine training, fiberoptic nasotracheal intubations are rarely performed. We report a case of a successful intubation in a patient with an acute upper airway obstruction later found due to angioedema. Emergency physicians should have routine training and access to fiberoptic equipment to provide optimal patient care.