Abstract
To the Editor:
We appreciate your interest in our case report, “Oropharyngeal Swelling and Airway Obstruction from Environmental Cold Exposure.” 1 Hopefully this response will help answer some of the questions raised.
Given the quantity of information involved in a case report such as ours, it is always difficult to strike a balance between the pertinent and interesting features of the case while removing the superfluous detail. We encountered a novel case of airway obstruction secondary to environmental cold exposure, and therefore, the focus of this report was the presentation and diagnosis of this rare condition. The fine details of the approach to airway management in a patient with impending airway obstruction are not a rare topic and are not unique to our case. Similarly, much of the information regarding the patient's care while in the hospital was intentionally omitted to focus on the unusual presentation of our case.
Regarding the question of hypothermia, we are happy to provide further information. At no point did the patient have a documented hypothermic temperature, and his temperature upon arrival at the hospital was 37.1 °C. As explained in our article, the patient was clinically diagnosed with facial frostbite, but the source of his airway obstruction remained a diagnostic dilemma. It is unclear how an additional diagnosis of hypothermia would have simplified this diagnostic approach, as suggested by Gupta et al. 2
We would also like to elaborate on the documented episode of prehospital hypoxia. Unfortunately, we have incomplete information regarding the prehospital component of this patient's care. The event in question occurred some 12 h prior to his arrival at the ED, and during transport, he had no further documented hypoxic episodes, no increased oxygen requirements, and no altered level of consciousness. Given the geography and remoteness of Northern Canada, there were no opportunities to provide definitive airway intervention early in the patient's clinical course. On his arrival at the tertiary care center in Winnipeg, the patient had an oxygen saturation of 97% on room air, was alert, and followed commands. It is the opinion of the authors that this episode did not represent hypoxia secondary to his airway obstruction.
Hopefully, we have been able to answer some of the relevant questions raised by Mohanty et al. Our hope is to continue to focus on the elements of this case that make it unique.
