Emergency Cricothyroidotomy for Acute Epiglottitis in a Patient With Super-Super Obesity: A Case Report

. Severe acute respiratory distress syndrome, biventricular systolic dysfunction, bilateral deep vein thromboses despite prophylaxis, and a peroneal compressive neuropathy followed. He went home on hospital day 46 with the cricothyroidotomy stoma still open. Three lessons follow. First, an improved response to steroids and epinephrine in supraglottic obstruction can still be temporary and should not be read as a trend. Second, in a patient of this size, one failed intubation attempt can be all that separates a stable airway from a "cannot intubate, cannot oxygenate" emergency. And, third, a cricothyroidotomy tube in a deep neck is not a definitive airway and may not hold its position, so the plan for converting it should be established before placement.