A 47 year-old female presents to the ED via basic life support ambulance with sudden onset of severe dyspnea after a witnessed choking episode while taking her daily medications.
On arrival: Morbidly obese female sitting upright in the stretcher with a non-rebreather mask. She appears diaphoretic with severe dyspnea and tachypnea. Her lungs were relatively clear to auscultation with only faint expiratory wheezes bilaterally. She is agitated and unable to follow commands. She appears cyanotic from the neck up.
Temp: 97.1°F (36.2°C), HR: 125 bpm, RR: 34, BP: 92/67, oxygen saturation was 82% on a non-rebreather mask.
Her ECG reveals a Sinus tachycardia without signs of ischemia or ectopy.
With an anticipated difficult airway, plans are made for RSI with apneic oxygenation. You mark the patient’s cricoid and the the cricothyrotomy kit is out. You initially plan your first attempt with bougie-aided direct laryngoscopy in a ramped position. You have video laryngoscopy back-up as well as a laryngeal mask airway if needed. You are able to intubate the trachea on your first attempt, though are unable to visualize any foreign body or airway edema.
All vital signs improve significantly after intubation and you obtain a post-intubation chest x-ray.
1. How would you interpret this chest x-ray ?
2. What would your next step be ?
3. What is your suspected diagnosis based upon the case presented so far ?