Some advice on a case of stridor presenting in the ER today.
65 yr old male patient rural african background presents with severe stridor arising from a lower neck/superior mediastinal compressing lesion the would appear clinically to be a huge retrosternal thyroid. The trachea is in the centre of the mass and impalpable. The mass has been slowly growing for years, the stridor is recent – worse over a few days. He is otherwise well. We temporise with adrenaline nebulisation and I plan exploratory surgery on the morrow. Working diagnosis is either malignant change or haemorrhage into a preexisting goitre. I discuss the options with him and he emphatically declines any surgery. He then has a respiratory arrest and needed intubation. Now we are a bit stuck. Any suggestions!