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.

Trauma Tribulation 001 CXR


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 001 Trachy tube and Tooth

Trauma Tribulations

Injury database

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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