EXTRAordinary Care
An elderly patient arrived via EMS in respiratory distress, initially treated as a possible asthma or COPD exacerbation. On evaluation, she was awake, alert, and following commands but unable to speak and moving minimal air. When asked to take a deep breath, she produced a brief, high-pitched upper airway sounds, raising concern for a mechanical obstruction.
With no clear history available and an exam that did not fit the initial impression, Dr. Casteel suspected a foreign body airway obstruction. While the patient was oxygenating adequately with supportive measures, her inability to phonate and minimal air movement signaled a potentially critical airway emergency.
Working alongside his colleagues, Dr. Casteel elected to perform an awake fiberoptic evaluation to better define the problem before intervening. After anesthetizing the airway, he advanced the scope and identified a mobile foreign body lodged at the level of the vocal cords, intermittently occluding the airway.
With the diagnosis confirmed, the team rapidly coordinated a plan. Roles were assigned, backup airway equipment was prepared, including backup intubation and surgical airway readiness. Using video laryngoscopy and forceps, Dr. Casteel successfully removed the obstruction in a single attempt.
The object was identified as a large, intact beet. Following removal, the patient immediately improved, regained her voice, and required no further airway intervention. She was admitted for observation and discharged the following day without complications.
The case highlighted the importance of maintaining a broad differential for respiratory distress and rapidly pivoting when the clinical picture does not fit the initial assumption.
