Question

A 27 year old female was brought to the emergency department for acute abdominal pain, following which she was shifted to the operation theatre for laparotomy. A speedy intubation was performed, but after the intubation breath sounds were observed to be decreased on the left side and a high end tidal CO2 was recorded. The likely diagnosis is:

• A. Endotracheal tube blockage
• B. Bronchospasm
• C. Esophageal intubation
• D. Endobronchial intubation

Hint:

A maintained CO2 trace with one quiet lung means the tube went too deep, not into the gullet.

Answer 1

The Correct Option is D

Step 1: Pick out the two key signs. Breath sounds are decreased on the left side, and there is a recorded end tidal CO2.

Step 2: A present end tidal CO2 trace confirms the tube is in the airway, not the oesophagus. Oesophageal intubation gives little or no end tidal CO2, so option C is excluded.

Step 3: Decreased breath sounds on the left with the tube in the trachea suggests the tube has advanced too far. Because the right main bronchus is wider, shorter and more vertical, a tube pushed in too deep usually enters the right main bronchus. This ventilates only the right lung, so the left side has reduced breath sounds.

Step 4: Exclude the rest. Total tube blockage would cause no ventilation and a loss of the CO2 trace, not unilateral findings. Bronchospasm causes bilateral wheeze with raised airway pressures, not a one-sided silent chest after a hurried deep intubation.

Step 5: Unilateral decreased breath sounds with a maintained CO2 trace after rapid intubation is classic right endobronchial intubation.

The answer is D. Endobronchial intubation.