Authors: Varsha Rao / Editor: Mark Winstanley / Reviewer: Peter Kilgour, Rebecca Ford / Codes: RC1, RC2, RP1, RP5, SLO5 / Published: 14/09/2021
A 3-year-old child was brought into the Emergency Department by their mum. The child was running up the stairs with a handful of pistachio nuts and fell face forwards. Mum noticed she started to breathe rapidly and became blue in the face.
Initial Obs:
HR – 130/min,
RR – 40-45 /min
Spo2 – 85% on room air
BP – 116/70mmHg
Temperature – 36
Respiratory System – Reduced air entry over left lung base. No audible wheeze.
No rashes noticed on examination.
She was given high flow oxygen. Saturations continued to deteriorate and she eventually needed Bag valve mask ventilation and was intubated in view of hypoxia.
15 responses
interest case…thanks
Good case! Thank you
Thanks, good case
Interesting case to consider.
Worth considering the logistics of this in a district general – once the child is intubated they will need to be transferred out to somewhere a bronchoscopy can take place. Could the FB dislodge en route and obstruct the ETT? Can this be prevented or ameliorated?
Similarly, what if intubation does not relieve the hypoxia due to lung collapse/VQ mismatch? Even the smallest adult sized flexible bronchoscope will probably be too large to fit down the 3-year-old’s ETT.
Thanks for this input. If it dislodges upwards towards the ETT, perhaps at that point you could attempt to suction it out, change the tube, or front of neck access? I considered pushing it back in if initial 2 options fail, but it could then go down the right and cause issues on that side and you will be compromised both sides then. Did you have any thoughts on what you would do next?
Good case
Good case
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Nice
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Thanks for the case.
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Interesting case.
intersting
Good revision