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Ludwig angina airway — RCPSC EM MCQ

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HardResuscitation, procedures, airwayLudwig angina airwayRCPSC EM

A patient with Ludwig angina has trismus, floor-of-mouth elevation and muffled voice but remains upright, cooperative and oxygenating on supplemental oxygen. What is the most appropriate airway plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Prepare a controlled awake airway with anesthesia and ENT support

The best answer is “Prepare a controlled awake airway with anesthesia and ENT support”. Deep neck infection can deteriorate abruptly and create a difficult airway. A cooperative patient who can maintain spontaneous ventilation is a candidate for a planned awake technique, with a second provider, anesthesia or ENT support, difficult-airway equipment and a surgical rescue plan. CT, antibiotics and dental care are important but must not delay airway planning; unplanned single-operator RSI can convert this into a failed airway.

Reference: Emergency Care BC: Awake Intubation: https://emergencycarebc.ca/clinical_resource/clinical-summary/awake-intubation/