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Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 120-123

Difficult airway management in a case of hair dye poisoning

Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Correspondence Address:
D Anandhi
Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_1_17

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Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Failure to secure the airway can drastically increase the morbidity and mortality of the patient within few minutes. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. Hence, knowledge of alternative measures to secure the airway and ventilate the patient is necessary. Prompt decision to proceed for emergency surgical airway (cricothyroidotomy or tracheostomy) is one of the utmost important rescue measures under such circumstances. Hesitating to perform this procedure may lead to repeated unsuccessful attempts at oral-tracheal intubation and inadvertently to hypoxia and subsequent brain damage and death. To an emergency physician, the main responsibility is to provide critical care and a definitive airway to all patients, regardless of the cause of their presentation. Here, we report a fatal case of hair dye poisoning that presented with severe angioedema and airway compromise. The most important take-home message from this case report is that every emergency physician should have the ability to predict “difficult airway” and recognize “failed airway” very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails. Any delay at any step in the “failed airway” management algorithm may not save the critically ill dying patient. In our patient, though we predicted the “difficult airway,” her brain had sustained irreversible hypoxic damage before we could provide oxygenation and ventilation. The following core competencies are addressed in this article: Medical knowledge, Patient care.

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