A 54-year-old woman developed a witnessed generalized tonic clonic seizure at work. Paramedics recorded a blood glucose level of 30 mg/dL. Despite normalizing the blood glucose level, the patient’s mental status did not improve, and she was intubated in the field. Given the limited view of the glottis, a tracheal tube introducer (Bougie) was used to facilitate intubation.
On arrival to the ED, the patient was awake and following simple commands. She was extubated but 1 h later developed somnolence and respiratory distress. After two unsuccessful attempts with direct laryngoscopy, she was reintubated using a videolaryngoscope with a size 7.0 endotracheal tube. During reintubation, there was difficulty obtaining adequate exposure of the glottis but no difficulty advancing the endotracheal tube through the vocal cords into the trachea.