Pulmonary Migration of a Fragment of Plastic Coating Sheared from a Stylet

Abstract Background In trauma patients, particularly with head immobilization, tracheal intubation without the use of a stylet may be impossible. Objectives To report a very rare but potentially fatal complication that may happen in any Emergency Department: fracture of the plastic sheath of an intu...

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Bibliographic Details
Published in:The Journal of emergency medicine 2013-06, Vol.44 (6), p.1097-1100
Main Authors: Chalhoub, Viviane, MD, Richa, Freda, MD, El-Rassi, Issam, MD, Dagher, Christine, MD, Yazbeck, Patricia, MD
Format: Article
Language:English
Subjects:
Adult
Bronchi - surgery
Bronchography
Bronchoscopy
embolization
Emergency
emergency intubation
Emergency Service, Hospital
Equipment Failure
foreign body
Foreign-Body Migration - diagnostic imaging
Foreign-Body Migration - etiology
Foreign-Body Migration - surgery
Humans
Intubation, Intratracheal - adverse effects
Intubation, Intratracheal - instrumentation
Male
stylet
trauma
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Summary:Abstract Background In trauma patients, particularly with head immobilization, tracheal intubation without the use of a stylet may be impossible. Objectives To report a very rare but potentially fatal complication that may happen in any Emergency Department: fracture of the plastic sheath of an intubation stylet, reported only twice before in the literature. Case Report Two large plastic fragments detached from a stylet while intubating a trauma patient. One piece was removed from the endotracheal tube a few hours later in the operating room. The second fragment migrated asymptomatically into the pulmonary airway. It was successfully retrieved from the right bronchus 24 h later. Conclusion This potentially life-threatening event may go unnoticed after intubation if the endotracheal tube is not obstructed by the fragment. Gentle withdrawal of the stylet from the tube is essential to avoid stylet fracture. Careful examination of the stylet after intubation may suggest a stylet fracture.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2012.11.004