A Study of Laryngeal Diseases Requiring Airway Management at Emergency Medical Care Center

Abstract

It is not common to encounter patients affected by respiratory distress. We received and treated five cases (three with laryngeal cancer, one with a deep neck infection and one with acute epiglottitis) of laryngeal diseases requiring airway management. Oral tracheal intubation was performed in all cases by emergency room doctor and consecutive tracheotomies were performed on two by otorhinolaryngologist. The 57 years old male patient who had a relapse of laryngeal carcinoma presenting dyspnea visited to our hospital. Although the patient was strongly recommended an urgent hospitalization and tracheotomy, he denied our recommendation. Unfortunately, he was transferred to the emergency medical care center in a cardiopulmonary arrest the next day. Except for this patient, all other patients were discharged from the hospital without any sequelae. In two of the five cases, final diagnoses were determined by an otorhinolaryngologist utilizing a flexible fiberscope and CT scan imaging. Once airway patency was established, the prognosis of these diseases was favorable. Management of airway intervention is as follows : The treatment of the laryngeal disease presenting dyspnea is limited to the medical institution that have enough medical staff, an intensive care unit and the inspection system. When the patient is in a life-threatening situation such as shock, apnea, unconsciousness, hypoxia, or unventilated then urgent oral intubation must be performed. When the patient is in a sitting position with stable cardiopulmonary function, nasal intubation using a fiberscope while they are awake should be performed. When the patient can maintain a supine position and has stable cardiopulmonary function then we can choose either tracheotomy or intubation.