History of Present Illness:
A patient age <1 is brought to the hospital for dyspnea after choking on a popcorn kernel. Initially the patient became cyanotic and lethargic and mom did a back blow maneuver and she improved but remained dyspneic and unconsolable. Prior to the even the child was in normal health and had no PMH.
Vital Signs & Physical Exam:
Pulse ox 90%, tachypneic, crying loudly with possible grunting but symmetric breath sounds
Initial Diagnostic Testing:
What is the most likely diagnosis?
- A) PTX
- B) Mediastinal shift
- C) Normal
- D) Infiltrate
- E) Visible foreign body
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWER:
- A) PTX
- B) Mediastinal shift – CORRECT. Shifted slightly to the right (volume loss on right v. hyperinflation on L)
- C) Normal
- D) Infiltrate
- E) Visible foreign body
1-Minute Consult on this topic: Click HERE and scroll to page 261.
CASE CONCLUSION: Gradually worsened over an hour and was intubated prior to transfer to local children’s hospital ICU by the CHET team. Post intubation x-ray showed R lung collapse. Marker notes tip of ET tube.
Bronched then taken to OR. Kernel found and removed from R mainstem bronchus
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