C19) Worsening hypoxia after intubation

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with hypoxia.
  2. Review the DDx considerations in a patient with hypoxia.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating a patient with hypoxia.


Physical Exam

Provisional Diagnosis

Select the Dx you believe is most appropriate
Worsening hypoxia following endotracheal tube (ETT) placement is likely secondary to a malpositioned ETT. ARDS usually develops five days following severe burn injuries.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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Emergent workup should take place considering the acute onset hypoxia.

First Imaging Study

What is the first imaging study you will order?

Chest-xray is readily available in the trauma bay, can determine ETT placement, and can assess for acute lung pathologies.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

No further imaging is required.
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What is your Diagnosis now that you have seen the imaging results?

The endotracheal tube should be 3cm above the carina and therefore should be retracted by 6cm.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

This patient with inhalational burn injury experienced respiratory distress secondary to a malpositioned endotracheal tube.

Assessment and Plan

Please provide your assessment and plan for this patient

This is a patient with inhalational burn injury who became increasingly hypoxic following intubation. Chest X-ray revealed a malpositioned ETT, which we will retract by 6cm.

Lessons Learned:
- A chest X-ray following intubation can assess for proper positioning of an endotracheal tube (in addition to directly visualizing the trachea during intubation, using exhaled CO2 or colorimetry, and confirming breath sounds).

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