A 'Bloody' hot stew

A 64-year-old woman presented to the emergency department with severe pain in her mouth after eating a hot meal the previous evening. She was discharged after an unremarkable clinical examination. The same night, she developed difficulty in speech and swallowing. On examination, the tongue was bruised and swollen with blood oozing from the back of the oral cavity almost occluding the airway. An urgent fibre-optic nasopharyngoscopic examination revealed gross swelling at the base of the tongue with posterior displacement of the epiglottis and subglottic oedema. Fibre-optic intubation was attempted because of the rapid progression of the swelling and compromised airway. The intubation provoked complete airway obstruction and an emergency cricothyroidotomy had to be performed with loss of ∼800 ml of blood. The trachesotomy …