A two days old baby presented with severe respiratory distress on examination he was observed to have a scaphoid abdomen and decreased breath sounds on the left side. He was managed by prompt Endotracheal intubation after ET tube placement the maximal cardiac impulse shifted fuher to the right side. What should be the next step in management?
The child in the question have congenital left sided diaphragmatic hernia. Incorrect placement of tube will result in distention of stomach and bowel loops in the left hemithorax which would inturn shift the mediastinum and apical impulse to the right. Confirmation of the position of the endotracheal tube or remove and reattempt intubation is the ideal next step in the management of this condition. As X ray cannot confirm the position the best answer is remove tube and re attempt intubation. Ref: Bailey and love 24th Edition, Page 873; Lee synopsis of Anaesthesia 13th Edition, Page 215
Confirm the position of endotracheal tube by chest X ray
Remove tube and reattempt intubation
Nasogastric tube inseion & decompress the bowel
Chest X ray to confirm diagnosis