A 60-year-old Man With Stridor, Drooling, and “Tripoding” Following a Nasal Polypectomy

Abstract

234 60-year-old man was discharged from outpatient A surgery following a left nasal polypectomy. There were no complications during surgery or extubation or during the postoperative period. En route to his home, the patient became extremely short of breath and diaphoretic. A friend who was with him immediately drove him to the emergency department. Upon arrival, the patient was in severe respiratory distress with marked stridor, drooling, and diaphoresis. He was unable to speak. The patient’s vital signs were as follows: blood pressure, 148/75 mm Hg; heart rate, 125 beats per minute; and respirations, 40 breaths per minute. Auscultation of both lung fields revealed poor air movement. His initial oxygen saturation on room air was 90%, increasing to 95% after we initiated high-flow oxygen at 15 L/minute via a nonrebreather mask. Unable to sit still, he assumed the tripod position, leaning forward and stretching his arms out to open his airway. We inserted 2 large-bore intravenous catheters, prepared for endotracheal intubation, and attempted to reassure the patient. The ear, nose and throat (ENT) surgeon arrived at the bedside within 5 minutes. A fiberoptic examination of the larynx demonstrated severe supraglottic and glottic edema. We administered racemic epinephrine, 0.5 mL in 3 mL of saline solution via a nebulizer, and 12 mg of dexamethasone, intravenously. Arterial blood gas (ABG) results were as follows: pH, 7.26; PO2, 157 mm Hg; and PCO2, 56 mm Hg, with a 99% saturation on 100% oxygen. We made several unsuccessful attempts to suction the patient’s trachea, hoping this would clear his airway of excess mucous, but his entire glottic area was too inflamed to allow the catheter to pass. The patient became increasingly anxious and diaphoretic with worsening stridor. With the assistance of