2 days after bih, child developed respiratory distress and had scaphoid abdomen. Breath sounds were decreased on the left side. After bag and mask ventilation, ET tube was put and the maximal cardiac impulse shifted to the right side. What should be the next step in management ?
Ans. is 'a' i.e., Confirm the position of endotracheal tube This is a case of congenital diaphragmatic hernia The clinical features suggesting this are:- Respiratory distress after bih with decreased air entry on the left side Scaphoid abdomen Mediastinal shift o In the above question, mediastinal shift occurred after bag and mask ventilation and endotracheal intubation. o So there is a possibility of wrong endotracheal intubation (i.e., endotracheal tube entered esophagus instead of trachea). o This caused distension of stomach with gas which resulted in mediastinal shift. So the confirmation of the position of the endotracheal tube should be done. o If the endotracheal tube is in proper position the next immediate treatment modality in this patient would be decompression of the gastric distension by nasogastric tube inseion.
Confirm the position of endotracheal tube
Emergency surgery
Naso gastric tube inseion
Chest x-ray