Endobronchial intubation

Case contributed by A.Prof Frank Gaillard

Presentation

Decreased oxygen saturation.

Patient Data

Age: Adult
Gender: Female
X-ray

Supine chest x-ray

Supine chest x-ray in an intubated patient, demonstrates the endotracheal tube located in the right main bronchus, probably past the origin of the right upper lobe bronchus. There is associated complete atelectasis of the left lung with marked shift of the mediastinum towards the left. Nasogastric tube in situ. 

Annotated image

The endotracheal tube (radio-opaque marker outlined in red dotted line) is beyond the trachea (blue dotted line) and into the right main bronchus. Nasogastric tube (yellow dotted line) seen as separate. 

Case Discussion

Endobronchial intubation is relatively common in patients intubated in a hurry, and although the chest is auscultated to ensure bilateral air entry, the tube can slowly migrate into the bronchus. 

While a well patient can easily survive on a single well ventilated lung, in the setting of trauma or acute illness, endobronchial intubation needs to be recognised and corrected expediently. 

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Case information

rID: 15330
Case created: 9th Oct 2011
Last edited: 7th Nov 2015
System: Chest
Inclusion in quiz mode: Included

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