Case 10: Changing a Nasotracheal Tube for an Oral Tube in the Intensive Care Unit
A 10-year-old boy, otherwise healthy, is admitted to the trauma center after a motor vehicle accident. He has suffered a fracture of the second cervical vertebrae without neurologic deficit. The fracture is managed with the application of a halo-fixator, and he is observed in the intensive care unit (ICU). Twenty-four hours later, he develops respiratory distress and pulmonary congestion. An electrocardiogram (ECG) reveals moderate aortic valve regurgitation, probably as a result of the blunt chest trauma. A decision is made to treat the pulmonary edema with tracheal intubation and intermittent positive pressure ventilator. The halo-fixator makes direct laryngoscopy impossible. A nasal endotracheal intubation is undertaken using the fiber-optic bronchoscope, without incident.