Presentation
Bradycardia and hypotension following induction of anesthesia. Increasing airway pressures and progressive hypoxemia. Cardiac arrest.
Patient Data
Supine AP CXR (Mobile)
The ETT extends beyond the carina into the right main bronchus. There is near-complete consolidation of the left lung with air bronchograms present, representing resorptive atelectasis in this clinical context. No significant mediastinal shift. Other possible causes for this appearance can include, for example, pneumonia, pulmonary edema and pulmonary hemorrhage.
Right internal jugular CVL is appropriately positioned.
Following retraction of the ETT, there has been significant re-aeration of the left lung. Persistent dense consolidation remains within the left lower lobe. The right lung remains well expanded with no focal consolidation.
Case Discussion
This case represents a classic example of right main bronchus intubation. The patient was intubated as part of induction of anesthesia for an elective surgical procedure. Unfortunately, high airway pressures were observed following intubation with the rapid development of bradycardia, hypotension and hypoxemia with subsequent cardiac arrest. Following a short period of cardiopulmonary resuscitation, return of spontaneous circulation occurred. This radiograph was taken immediately on admission to ICU. The etiology of this event may be secondary to the drugs used during induction or as a result of excessive stimulation of vagal tone with direct laryngoscopy, which has been reported in case studies1.
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