“Wait, What Is That in There?” An Unexpected Airway Finding During Intubation

A 63-year-old male presented to the emergency department (ED) by emergency medical services (EMS) as a stroke alert. His mental status declined during transport, and he arrived at the ED unresponsive, with bag-valve mask ventilation in progress. The patient’s oxygen saturation remained around 93% to 95% despite receiving 100% oxygen via the bag valve mask. Endotracheal intubation using video laryngoscopy (VL) was performed. During VL, a tube was noted in the posterior oropharynx, passing through the vocal cords (Fig 1).