Breathing on the Brink: Emergent Tracheostomy for Undiagnosed Subglottic Stenosis

Sub-glottic stenosis is the narrowing of the upper airway below the glottis and can be congenital, acquired or idiopathic. Post-intubation acquired sub-glottic stenosis is rare, and the primary diagnosis often gets delayed until intubation is attempted. We report one such case of a failed intubation in the emergency department secondary to undiagnosed sub-glottic stenosis leading to emergency tracheostomy in a 24-year-old male. Patient was treated with nebulisation of beta two agonists and inhaled corticosteroids on the lines of obstructive airway disease. A trial of non-invasive ventilation was given with no improvement in symptoms. As a result of non-tolerance to Non Invasive Ventilation (NIV), endotracheal intubation was planned and attempted. This resulted in a scenario of failure to intubate and failure to ventilate when decreasing sizes of endotracheal tubes and bougies could not be passed beyond the vocal cords. Emergency surgical tracheostomy was performed by the emergency physician, and the airway was secured, following which there was an improvement in the patient’s symptoms.