Tailoring Dynamically At-Risk Airway Management in an Impacted Safety Pin: A Near-Miss Case Report

Sharp foreign bodies lodged in the pharynx represent an airway emergency that is more than a single fixed anatomical problem.A 13-year-old girl presented after accidental insertion of an open safety pin into the nasopharyngeal region, with the pin having a descending trajectory towards the laryngopharynx.On examination, there was mucosal swelling with minimal oozing.Potential complications included loss of spontaneous airway tone, with a risk of posterior migration of the pin; conversion of oozing to active bleeding from accidental foreign body manipulation during airway management; and aspiration related to bleeding.Further, the patient was not fasted, and shared airway management and anesthesia maintenance with the surgical team also added to the challenges.The plan, therefore, focused on securing the airway while preserving spontaneous breathing under sedation, using video laryngoscopy (VL).Awake fibreoptic intubation (AFOBI) was considered but was thought to be technically difficult due to a sharp foreign body in the nasopharynx, and the possibility of conversion into active bleeding if it were manipulated.The airway was secured on second attempt using a C-MAC D-blade, and the foreign body was subsequently retrieved surgically.A brief episode of mild desaturation was noted by the time the trachea was intubated.This case highlights the compound and dynamic airway risks associated with sharp foreign-body impaction, which should be managed as a near-miss requiring structured, awake, shared-airway planning.In our case, VL with preserved spontaneous breathing effort seemed a rational first-line technique given the technical difficulties and bleeding risk that could make fibreoptic visualization unreliable, and it offered the potential advantages of tolerance, less force, and a higher likelihood of no-touch to the palate during laryngoscopy compared with conventional direct laryngoscopy.