• Aaron E Robinson, Matthew E Prekker, Robert F Reardon, Elisabeth K McHale, Sarah M Raleigh, and Brian E Driver.
• Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota. Electronic address: aaron.robinson.em.md@gmail.com.
• J Emerg Med. 2022 Jun 1; 62 (6): 789-792.

BackgroundAbnormal anatomy complicates emergency airway management. In this case, we describe definitive airway management in a critically injured emergency department (ED) patient with a history of partial tracheal resection who had a Montgomery T-tube, a type of T-shaped tracheal stent, in place at the time of the motor vehicle collision. The Montgomery T-tube is not a useful artificial airway during resuscitation, as it lacks a cuff or the necessary adapter for positive pressure ventilation.Case ReportWe describe a case of a 51-year-old man who required emergency airway management after a motor vehicle collision. The patient had a Montgomery T-tube in place, which was removed with facilitation by ketamine sedation and topical anesthesia. The patient was successfully intubated through the tracheal stoma after removal of the T-tube. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must recognize the Montgomery T-tube, which resembles a standard tracheostomy tube externally, and have some understanding of how to manage a critically ill patient with this rare device in place. When a patient with a Montgomery T-tube in place requires positive pressure ventilation, the device may require emergent removal and replacement with a cuffed tracheostomy or endotracheal tube.Copyright © 2022. Published by Elsevier Inc.

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