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A previously well 62-year-old man was admitted to a regional hospital, with scalp swelling, headache, fever and rigors following a scalp injury 3 weeks prior. He developed meningism with progressive left-sided hemiparesis, and had a focal seizure on his fourth day of admission. Following a generalised seizure on day 5 of admission, he was referred to a metropolitan tertiary hospital, for neurosurgical intervention of an extradural and subdural empyema.
Prior to transfer by the Royal Flying Doctor Service, he required a definitive airway and was taken to the emergency department, for sedation and intubation. Two unsuccessful attempts at orotracheal intubation were performed by the emergency physician, followed by successful placement of a laryngeal mask airway (LMA). The decision to attempt surgical cricothyroidotomy was made as the LMA did not suffice as a definitive airway. A vertical incision in the skin of the anterior neck exposed what was believed to be the cricothyroid membrane (CTM). Three attempts at insertion of an endotracheal tube …