1 day old. 36 weeks preterm. Shocked at delivery. Resuscitated and transferred to NICU (Neonatal Intensive Care Unit)
Answer: ET tube in right main bronchus with collapse of left lung. Umbilical venous catheter would appear to be in the left atrium likely having passed through an atrial septal defect (ASD) or patent foramen ovale (PFO).
We have 2 stars for this thread : Dr Kangourou who presented this interesting challenge and Dr. Sampath ( really smart !!! ) who clinched the diagnosis. Now, sometimes even if the ETT is well above the carina, u can get a similar differential air entry. It's courtesy the 'CONADA EFFECT'. I will try and illustrate it with a few ( self made ) images. For those who may be wondering about the "Conada Effect" - it just means than when a fluid moves past a curved surface it loves to caress it, creating a venturi like effect. I cud hav easily used another example, than this boring candle and jar...but U guys are free to imagine...... A similar situation is encountered during intubation. The ETT is above the carina and you still may have asymmetric rise of the chest wall. It's because the the ETT tube is slightly twisted on it's axis as demonstrated below. So if withdrawing the ETT dosen't help, think of this possibility and try changing/correcting the axis of ETT. A similar situation is seen in supravalvular aortic stenosis the jet of blood caresses the indentation caused by supravalvular aortic stenosis and curves preferentially into one of the subclavian arteries thus giving an exaggerated diff in bp measured in both arms. The Conada effect is also advantageous. The aerodynamic expert Conada, first used it to make better aircraft designs and the benfits were then extended to make faster trains. Today it has a new application: in theconstruction of high rises in windy places. In windy conditions, the traditional matchbox shaped high rises will have a daming effect on the wind currents (which causes the building to sway and can be a little scary for people on the top-most floors), but if the building is shaped like a capsule or jar, then the Conada effect comes into play leading to less swaying.
A classic case of migration of ETT A 5-month-old infant is anesthetized for correction of an eye condition. Immediately after intubation bilateral breath sounds and chest excursion are noted and there is 100% oxygen saturation with an FIO[SUB]2[/SUB] of 0.5. After positioning for surgery, the oxygen saturation is noted to have dropped to 94%, no other changes having been made. The most likely cause for this fall in oxygen saturation is A. a kinked endotracheal tube B. bronchospasm C. migration of the endotracheal tube into the right mainstem bronchus D. inspissated secretions plugging the tube E. a failure in the anesthesia machine When a small but persistent change in oxygen saturation is noted, the position of the endotracheal tube must be reassessed. The other causes noted above are also possibilities in this situation but are less likely. Ans C
