Multiple factors responsible for fatal outcome in 14-month-old child with 4.5cm right angled metallic nail in the bronchus
Received 1 October 2009; received in revised form 11 January 2010; accepted 12 January 2010. published online 11 February 2010. Corrected Proof
Abstract
We report a child who died after an attempt to remove a 4.5cm metallic angled nail from the bronchus of an 18-month-old child. This case highlights a number of problems which can complicate foreign body extraction in small children:
•Delayed diagnosis: often misdiagnosed as asthma.
•Sudden deterioration: no time to plan approach.
•Minimal stridor may be present with low airflow.
•Intubation: this risks distal dislodgement of foreign body.
•Laryngeal lumen in children under 18 months will often not accept optical forceps.
•Edema from manipulation worsens an already precarious situation.
The sudden deterioration requiring intubation was the critical point in this case. If at all possible intubation should be avoided.
aDepartment of Otorhinolaryngology and Head and Neck Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
bDepartment of Anaesthesiology and Critical Care, B P Koirala Institute of Health Science, Dharan, Nepal
Corresponding author at: Department of Pediatric Otolaryngology, Chacha Nehru Bal Chikitsalaya - Pediatric Hospital, affiliated to Maulana Azad Medical College, Geeta Colony, Delhi, India. Tel.: +91 11 22378498.
ABSTRACT
cm right angled metallic nail in the bronchus