Acute airway obstruction from a retropharyngeal hemorrhage

A case is reported of a man in his 70s that presented to the emergency department due to difficulty swallowing after a fall. He was found to have a large retropharyngeal hematoma, which led to complete airway obstruction about an hour after the injury. As oral endotracheal intubation was impossible due to the bleeding, an emergency cricothyrotomy was performed in an ambulance by an emergency medicine trainee. The patient was then transferred to Landspitali for further treatment, but was discharged home in good health 19 days later. Retropharyngeal bleeding following trauma is rare. A pre-hospital cricothyrotomy has not previously been reported for this injury.