Establishing life-saving airway by withdrawing a deliberately placed endobronchial tube in a polytrauma patient

Airway management in polytrauma patients can create unanticipated challenges, particularly in the presence of tracheal injury. A 24-year-old male who suffered a road traffic accident was diagnosed with complete tracheal disruption with a gap of 3.5 cm with minimal external signs of injury. Initial intubation attempts revealed resistance at 18 cm from the angle of the mouth with the endotracheal tube creating a visible contour just below the skin in the midline of the neck. Associated palpable crepitus in the neck led to the suspicion of tracheal disruption. The patient was then intubated using a bougie. The tube was pushed into the bronchus distal to the suspected gap and then withdrawn to lie just above the carina, thereby providing adequate ventilation and preventing further development of subcutaneous emphysema. Associated injuries were managed by multidisciplinary consultations. Prompt thinking and quick clinical decisions with respect to the airway proved to be life-saving for the patient.