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Tracheal Irrigation Without Bronchoscopy as an Alternative Emergent Treatment of Blood Aspiration

  • Sangun Nah
    Affiliations
    Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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  • Sungwoo Choi
    Affiliations
    Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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  • Author Footnotes
    1 Gi Woon Kim and Sangsoo Han contributed equally to this work.
    Gi Woon Kim
    Footnotes
    1 Gi Woon Kim and Sangsoo Han contributed equally to this work.
    Affiliations
    Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 Gi Woon Kim and Sangsoo Han contributed equally to this work.
    Sangsoo Han
    Correspondence
    Reprint Address: Sangsoo Han, md, Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon 14584, Republic of Korea
    Footnotes
    1 Gi Woon Kim and Sangsoo Han contributed equally to this work.
    Affiliations
    Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 Gi Woon Kim and Sangsoo Han contributed equally to this work.

      Abstract

      Background

      Tracheobronchial foreign body aspiration can cause mild symptoms but may also become dangerous enough to cause death. Bronchoscopy is the first choice for the diagnosis and the removal of aspirated foreign bodies. So, when bronchoscopy is not available, the situation might get challenging.

      Case Report

      A 62-year-old man was waiting for emergent surgery for traumatic epidural hematoma in the Emergency Department (ED). Endotracheal intubation was performed for surgery and airway maintenance. However, oxygen saturation dropped and respiratory arrest was expected. As emergent bronchoscopy could not be performed, the emergency physician decided to irrigate the trachea by using 0.9% normal saline in the ED. After three rounds of irrigation, vital signs including oxygen saturation improved and the patient could undergo neurosurgical surgery. The patient was subsequently discharged with improved health.

      Why Should an Emergency Physician Be Aware of This?

      Bronchoscopy is the first choice for the treatment and diagnosis in cases of bronchial aspiration of blood, such as that caused by epistaxis. However, in emergency situations, such as deteriorating vital signs due to aspiration of life-threatening amounts of blood from epistaxis, using blind tracheal irrigation as an alternative tool when bronchoscopy is not available can help in achieving clinically acceptable results.

      Keywords

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