Can’t Intubate, Can’t Oxygenate: A Rare Case of a Difficult Airway due to Nonhereditary Angioedema

Abstract

Angioedema is a form of allergic mediated by histamine and non-allergic mediated by bradykinin and can be lethal if not recognized and treated promptly. This case demonstrates the proper diagnosis of and intervention in rapid onset severe angioedema.A 68-year-old male came to the emergency department with a complaint of dyspnea that started two hours before. he had type ii diabetes, chronic kidney disease and several different antihypertensive medications, including an ACe inhibitor for hypertension. during physical examination, the patient was hypertensive, tachycardic, tachypnoic, and edematous. during his stay in the ed he was treated with a combination of corticosteroids, antihistamines and epinephrine, but the patient's edema and dyspnea worsened and his oxygen saturation started to deteriorate with a progression of skin edema. intubation was not possible due to the large edema of the tongue, so a tracheotomy was done. An ampule of icatibant was administered and rapid regression of the edema, along with the stabilization of the patient's vital signs, followed after five minutes. The patient was discharged home after five days with a recommendation of discontinuing the ACe inhibitor.while non-hereditary angioedema is not a rare condition, emergency physicians should be adequately educated about it.

The Use of Tranexamic Acid in Dermatology

“…Although its efficacy is lower than that attenuated androgens and is not recommended as first-line prophylaxis, it is preferred in pediatric population because of its more favorable side effect profile 24 . Acquired angioedema can be idiopathic, caused by C1-INH deficiency or by drug intake, most often angiotensin-converting enzyme (ACE) inhibitors 25 . Beauchêne et al conducted a retrospective study to evaluate the benefits of emergency use of TXA in the treatment of ACE inhibitor-induced angioedema episodes.…”