It’s not a bird or a plane…

aka Trauma Tribulation 001

An 18 year-old man has been in ICU for 7 days after jumping from a building.  A tracheostomy was performed yesterday.  He has now developed acute respiratory distress and you are unable to pass a suction catheter through the tracheostomy tube.

This chest X-ray was taken a few hours prior to the onset of his respiratory distress.


Q1. Describe the chest X-ray.

Answer and interpretation

There is a tracheostomy tube in appropriate position and a central line in appropriate position. There is a tooth in the right main bronchus which on review of chest X-rays taken in the previous week had been there every day!

Q2. What immediate intervention is required?

Answer and interpretation

The immediate intervention required is removal of the tracheostomy tube – the inability to pass a suction catheter indicates that the tracheostomy tube is blocked.

This the tracheostomy tube and the tooth:


Trauma Tribulation

Intensivist in Wellington, New Zealand. Started out in ED, but now feels physically ill whenever he steps foot on the front line. Clinical researcher, kite-surfer  | @DogICUma |

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