[Acute upper airway obstruction in a 2 year old child; when an inspiratory stridor is not what it seems].

A toddler with upper airway obstruction was admitted to a peripheral hospital, with a differential diagnosis of laryngitis subglottica, unresponsive to treatments and deteriorating. The child was brought to theatre for airway management. After induction, the glottic opening was not visible. Several attempts using different techniques, adjuncts and staff were not successful and a cannot intubate cannot oxygenate scenario, severe hypoxemia and cardiac arrest occurred. After minutes, a scalpel tracheotomy led to reoxygenation and return of circulation. After transfer to a tertiary center, rigid laryngoscopy showed an almost complete obstruction of the airway by laryngeal papillomatosis. After debulking, the child went to the PICU where he passed away due to irreversible neurological damage. Our patient brought together two teams from two hospitals. We share learning points for healthcare workers and policy makers responsible for pediatric airway care and how emergency front of neck airway differs from (young) adult airway management.