2024 FSA Podium and Poster Abstracts

P099: PEDIATRIC AIRWAY EMERGENCY: FOREIGN BODY REMOVAL FROM ENDOTRACHEAL TUBE FOLLOWING INTUBATION OF 6-YEAR-OLD MALE
Ellie Zhang, BS; Drew Hicks, DO; Lydia Jorge, MD; University of Miami Miller School of Medicine

Introduction: Foreign body aspiration (FBA) poses a significant danger to children, contributing to approximately 150 deaths in the United States in 2021 among children aged 0-14, with a predominant impact on those within the 0-4 age group [1]. Diagnosis within 24 hours occurs in only 50-60% of cases, emphasizing the importance of suspecting FBA early to prevent complications [2]. While the classic triad of wheeze, cough, and diminished breath sounds is often linked to FBA, a review of 135 cases showed it only present in 57% of cases, with high specificity (96-98%) but low sensitivity (27-43%) [3]. Children's airways differ from adults', with less preference for the right vs left main bronchus due to their underdeveloped airways. Examination of the tracheobronchial tree is crucial in high suspicion FBA cases, with rigid bronchoscopy preferred for object removal. Delayed diagnosis can lead to severe complications like atelectasis, pneumonia, and death, highlighting the urgency of prompt recognition and intervention.

Methods: Individual case of pediatric airway emergency at a single trauma center. Clinical data was collected from the electronic medical record system.

Results: The case presented is of a 6 year old male with no past medical history who presented to Ryder Trauma Center from outside hospital after sustaining flame burns to the anterior upper torso after his shirt caught on fire from a candle. Patient sustained 2nd and 3rd degree burns to the anterior torso, abdomen, and right upper extremity with a total body surface area of 11.5%. The plan was to go to the OR for a split thickness skin graft of the upper torso.

The patient was premedicated with 1mg of Versed. Standard induction was performed using 25mcg of Fentanyl, 50mg of Propofol, 30mg of Rocuronium, and 20mg of Ketamine. During the first intubation attempt, a MAC 3 blade provided a grade 1 view, and a 5.5mm endotracheal tube (ETT) was successfully placed. However, upon removing the stylet from the ETT, it was observed that the plastic tip was missing from the stylet. Upon examination, the plastic tip was found to be suspended in the lumen of the ETT. The ETT cuff was promptly deflated, and the ETT was slowly withdrawn from the trachea. Subsequently, upon complete removal from the mouth, the plastic tip was no longer within the tube's lumen but was discovered in the oropharynx. Fingers were avoided for retrieval, and Magill forceps were utilized to grasp and remove the object. The patient was reintubated with a MAC 3 blade, achieving a grade 1 view, and a 5.5 ETT was secured 16cm at the lips. Throughout this incident, the patient remained hemodynamically stable with no desaturations. The remainder of the anesthesia procedure proceeded uneventfully.

Discussion: This case aims to discuss foreign body aspiration (FBA) diagnosis and management in pediatric patients. In cases suspicious of FBA, rigid bronchoscopy is the preferred method for identification and object removal. A high suspicion for FBA is crucial to prevent subsequent complications like atelectasis, pneumonia and death.