Author(s)
Qasim Husain, MD
Kenny F. Lin, MD
Rahmatullah W. Rahmati, MD
Affiliation(s)
New York Presbyterian Hospital - Columbia University Medical Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the most common indications and usage patterns of flexible fiberoptic laryngoscopy in the emergency room and understand how this intervention may guide management. Objectives: To evaluate the usage of flexible fiberoptic laryngoscopy (FFL) in the emergency room (ER) setting and delineate the indications for its use and potential benefits. Study Design: Retrospective analysis. Methods: Six months of consultations to otolaryngology-head and neck surgery service at a tertiary care center were examined. The inclusion criteria for the study were adult consultations from the emergency room involving an upper airway evaluation with flexible fiberoptic laryngoscopy. Those consultations that were included in the study provided the reason for consult, laryngoscopy findings, whether repeat examination was required versus intubation, and finally patient disposition. Results: During 6 consecutive months there were 111 adult consultations generated from the emergency department that involved the use of FFL for upper airway evaluation. The most common chief complaint or indication requiring flexible FFL in the ED was angioedema, followed by foreign body sensation, and allergic reaction. Out of a total of 111 evaluations there were positive findings elicited in 31 cases (27.9%). When positive findings were elicited, repeat scope exams occurred 45% of the time, whereas 13% of cases were intubated based on findings. Patients were admitted for further monitoring in 52% of cases, compared to 6 hours of ED observation in 48% of cases. Conclusions: Flexible fiberoptic laryngoscopy is a frequently used tool in the emergency room to evaluate patients with respiratory distress, foreign bodies, dysphagia, and odynophagia. Positive findings on laryngoscopy can often dictate the next step in management, as well as determine the safest disposition for the patient.