Postintubation Tracheal Perforation While on Long-Term Steroid Therapy: A Case Report |
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| Authors: | Yahia Akeely Gary M Vilke Hassan Alzahrani Ibrahim Alshowaihi Ashraf Alsaadani Abdulrahman Rabah Abdulrahman Turkistani Mohammad F Abosamak |
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| Institution: | 1. Department of Emergency Medicine, Security Forces Hospital, Riyadh City, Kingdom of Saudi Arabia;2. UC San Diego Health System, San Diego, California;3. North County Dispatch Joint Powers Authority, Santa Fe, California;4. Emergency Medicine Department, Aseer Central Hospital, Abha City, Kingdom of Saudi Arabia;1. Department of Emergency Medicine, University of California, San Diego, San Diego, California;2. Department of Anesthesiology, Division of Critical Care, University of California, San Diego, San Diego, California;3. Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, California;1. Department of Pharmacy, Baptist Health, Montgomery, Alabama;2. University of Massachusetts Medical School, Worcester, Massachusetts;3. School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania;4. State University of New York, Upstate Medical University, Syracuse, New York;1. Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas;2. Carolina Children''s Eye Care, Greensboro, North Carolina;1. Department of Radiology, E-Da Hospital, Kaohsiung, Taiwan;2. School of Chinese Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan;1. Division of Emergency Medicine, Temecula Valley Hospital, Temecula Valley, California;2. University California San Diego, La Jolla, California |
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| Abstract: | BackgroundEndotracheal intubation is an essential basic skill for emergency physicians. The procedure can cause complications that should be recognized. Awareness and early identification of complications are needed to allow early intervention to optimize outcomes. The risk factors for tracheal perforation during intubation are typically related to the physician skill and experience and to the patient's comorbidities, including body habitus and chronic use of certain medications.Case ReportWe report a case of a 45-year-old man with renal transplant on tacrolimus and prednisolone for 16 years. He presented with decreased level of consciousness due to an acute intracranial hemorrhage and was intubated for airway protection. Post intubation, a significant subcutaneous emphysema was noted on the patient's neck and chest, which was subsequently determined to be caused by a tracheal perforation. The management of tracheal injury depends on the size and location of the tear, as well as the patient's clinical status and comorbidities. In this case, the tracheal perforation was treated conservatively and was successful.Why Should an Emergency Physician Be Aware of This?This case has been reported to increase awareness about this rare and potentially life-threatening event. The prevention of this rare injury can be difficult but use of a slightly smaller endotracheal tube in a high-risk patient can be of benefit. In addition, early consideration of this complication when there is an acute change in physiologic status will allow for rapid facilitated management. |
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| Keywords: | tracheal perforation tracheal penetration tracheal laceration tracheal injury steroid use intubation complications |
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