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.
Questions
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:
CLINICAL CASES
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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