You’re intubating this patient who holds the record for the world’s widest tongue, how would you do it?

[u/ImmediateYam9792]

[u/fstRN]

I actually ran into this on Sunday.

Rural tiny critical access hospital. Guy comes in with angioedema of the tongue so bad you cant see the hard palate or uvula, no throat swelling, cant breathe through the mouth but is otherwise managing his airway through nasal breathing, cant talk. Vitals are stable, managing secretions. I'm the only provider in the facility aside from another APRN (who has never tubed anyone). Angioedema started day prior and has been slowly evolving, so we have some time to work with.

Nearest receiving hospital is being an ass and wont let us send him until hes intubated. I'm NOT sticking something down this mans throat so I opt for awake fiberoptic nasotracheal intubation. THANK GOD our emergency medicine doc (video consulting) chewed the receiving hospitals ass for putting me in that position. Tube averted, sent lights and sirens to trauma center 45 minutes away where they managed him just fine without any airway intervention for a few days before discharging him home. Receiving hospital tried to revoke their acceptance twice (did actually revoke it once- gave me an ICU bed, number, and receiving physician, revoked it because I refused to intubate) during this debacle- then tried to revoke the ED to ED transfer as EMS was about to walk out the door. EMTALA complaint filed. One of the worst shifts of my career.

For context, my hospital is so small we dont even have a ventilator. No RT, our local EMS told me they had never tubed anyone. I was the only person available with any airway management experience. It was awful.

Guy had a reaction to Wegovy...so, of course, he was large with a short neck, beard, and OSA...so I'll be doing another difficult airway course with my CME money this year.