2000 OPEN FORUM Abstracts
TOOTH ASPIRATION DISCOVERED ON REINTUBATION
Mary Stone RRT, Alexander B. Adams RRT, Chris Carter M.D. Regions Hospital, St. Paul, MN
Introduction: Foreign body aspiration (FBA) in children has been well documented. Objects such as peanuts and other organic material are most commonly reported with reports of fatalities due to balloon aspiration. The incidence of adult FBA, however, is less common and related more to the patient's age and physical condition. Adults aspirate objects such as vegetable matter, meat, bones, dental appliances, with reports of aspirating beverage can pulltabs, a brillo pad crack screen, a spinhaler propeller, and a small dental screwdriver.
Case Summary: A 66 year old man presented in the ER with complaints of chest pain, dyspnea, and syncope over a two day period. 02 saturation was 75% on room air and 88-92% on via non-rebreather mask. After a short run of asystole the patient was emergently intubated, placed on mechanical ventilation and stabilized in the MICU. A subsequent CXR found a right pleural effusion without identifying a focal lesion at that time. A transcutaneous pacemaker was used to control the asysolic episodes. An attempt at extubation failed due to desaturation and respiratory distress. During reintubation, a foreign body was seen in the left mainstem bronchus. The foreign body could not be extracted by flexible bronchoscope, therefore, rigid bronchoscopy was performed. Under anesthesia, a #7.5mm Storz rigid bronchoscope allowed the extraction of a molar tooth with an alligator forceps. During the procedure the patient was ventilated with a Saunders Venturi Jet ventilator. The patient remained stable throughout the remaining hospital course and was discharged in his usual state of health.
Discussion: The flexible fiberoptic bronchoscope was first introduced in the late 1960's. While it's use in the safe removal of foreign bodies in adult FBA is successful in most patients, the rigid bronchoscope is required for difficult extractions of large foreign bodies. Aspiration in adults is seen in all deciles with peak incidence in the 6th decade. Certain factors predispose to FBA such as neurological disorders affecting protection of the upper airway and dental procedures. In this case, a FBA was not evident until the roots of a molar tooth were seen during reintubation. After canvassing local hospitals, adult large FBA incidence is estimated at 1/100,000/year, a relatively rare event requiring the use of rigid bronchoscopy.