Airway management in suspected laryngotracheal trauma in an uncooperative patient

Summary I report laryngotracheal trauma in an uncooperative patient. He had attempted to hang himself with rope and in the process sustained an obvious, transverse, anterior neck abrasion. He was uncooperative without ketamine sedation. Securing the airway was our clinical priority. Tracheal intubation without visual guidance risks worsening airway injuries, creating a false passage and even complete loss of airway control. Airway management, with minor modification, followed a recently published mental model for blunt laryngotracheal trauma. The modification was passing a fibrescope between the vocal cords without the use of a tracheal tube placed at the laryngeal inlet as a conduit. Advantages of this modification include a smaller diameter device entering the trachea that also never passes beyond the cords in a blind fashion.