A Battle For Breath

In the high-stakes environment of the ED, quick thinking and decisive action can mean the difference between life and death. Recently, a 51-year-old woman entered this critical space, her history of OSA and HTN and unrecognized anterior neck mass, setting the stage for a dramatic and harrowing medical journey.

She arrived at the ED with rapidly worsening shortness of breath, orthopnea, and drowsiness that had escalated over the past day. Though her blood pressure was stable, her heart rate was racing, her breathing was labored, and she was dangerously desaturating even on 15 liters of oxygen. Non-invasive ventilation was quickly attempted but proved ineffective.

Recognizing the gravity of the situation, the ED team sprang into action. The decision to intubate was made—a critical and timely call. But this was no ordinary intubation. A massive thyroid gland was compressing her airway to the left, transforming the procedure into a high-stakes challenge. After three failed attempts, success finally came on the fourth, utilizing a C-MAC video laryngoscope and an Eschman ETT introducer—essential tools in navigating this anatomical obstacle (and for airway’s sake, let’s not call it a gum elastic bougie).

With her airway secured, she was swiftly transferred to the ICU. Here, a new dilemma emerged. The ICU team initially recommended a DNR Pharma status, reflecting the severity of her condition. However, her family, embodying hope and determination, opted for full code status, choosing to fight for every possible chance of survival.

An ENT specialist was urgently consulted and performed a life-saving total thyroidectomy. The surgery was a remarkable success, and the patient remained stable in the aftermath, her vital signs steadying as the days progressed.

In a remarkable turn of events, this brave woman—who had navigated life-threatening challenges and overcome them with the relentless support of a dedicated medical team—is now preparing to go home. Her journey from the ED to the ICU, and ultimately to recovery, stands as a powerful testament to her resilience and the unwavering efforts of all the medical specialties who refused to give up on her.

One of the most crucial decisions in this entire process was the timely choice to intubate, a move made by the ED team that undoubtedly played a pivotal role in saving her life. This case underscores the importance of rapid, decisive action in emergency medicine and the profound impact it can have on patient outcomes.

As she leaves the hospital, this patient's story serves as a beacon of hope and a reminder of the extraordinary capabilities of emergency medicine when combined with human determination and expertise. From the brink of crisis to the cusp of recovery, her battle for breath has been nothing short of inspirational.