Presentation
Exogenous intoxication. Brought by responders to the emergency department already intubated and with a nasogastric tube positioned (NGT) for gastric lavage and administration of activated coal.
Patient Data
Two tubes descend the trachea. The endotracheal tube is correctly positioned and ends a few centimeters above the carina. The nasogastric tube is malpositioned, instead of descending the esophagus, it descends the trachea into the right lower lobe bronchus.
Case Discussion
Tube positioning should always be verified. Administration of a gastric lavage, drugs, or diet via a malpositioned nasogastric tube could be catastrophic for the patient.
A correctly placed NGT should:
follow the course of the esophagus near the midline
bisect the carina
cross the diaphragm
have its tip and side-hole below the left hemidiaphragm
Unable to process the form. Check for errors and try again.