Near-Fatal Aspiration of Drug Contraband

This case report describes a near-fatal airway obstruction in a woman attempting to conceal drug contraband in her mouth. A patient was brought to the emergency department by emergency medical services accompanied by police after she had refused to open her mouth after being detained. The patient was initially seen at triage, being awake and responsive, but still refusing to open her mouth. While in the emergency department, she rapidly deteriorated exhibiting signs of upper airway obstruction. The patient had aspirated a plastic bag presumably containing "crack" cocaine which completely occluded her trachea. Immediate intervention consisting of direct laryngoscopy and forceps removal of the foreign body was necessary to preserve life. The case is presented as a warning to law enforcement, emergency physicians, and other first responders that a patient who will not open their mouth while attempting to conceal narcotics is at risk for aspiration, airway obstruction, and death. Patients presenting to the emergency department with this history should be closely monitored in a high-acuity area with anticipation of the need for emergency intervention to achieve and maintain airway patency.