Internal Findings Intubation

In the series of intubated individuals, the following injuries were observed: (208,211,212):

• Chipped or loosened teeth.

• Contusions or lacerations of base of tongue, epiglottis, piriform recess.

• Petechiae of epiglottic mucosa.

• Laryngeal mucosal edema, contusions, petechiae (glottic and subglottic [90,213,214]).

• Laceration of epiglottis; other lacerations (glottic, hypopharynx [214-217]).

• Glottic stenosis as a long-term complication owing to ischemic ulceration from pressure; tracheostomy also leads to subglottic stenosis (213).

• Tracheobronchial lacerations or rupture (218-220).

• Esophageal rupture.

• Superficial and deep neck muscle hemorrhages (210)

• Hyoid and thyroid cartilage fractures rare (90,208,221).

Fig. 41. Attempted resuscitation of a child. (A) Nasogastric tube in left nostril. Note small abrasions, left nostril (largest indicated by arrow). (B) Endotracheal tube (long arrow). Exposed end cut to allow lips to be examined. Lip contusions (arrows). Abrasion near left corner of mouth (arrowhead).

Fig. 41. Attempted resuscitation of a child. (A) Nasogastric tube in left nostril. Note small abrasions, left nostril (largest indicated by arrow). (B) Endotracheal tube (long arrow). Exposed end cut to allow lips to be examined. Lip contusions (arrows). Abrasion near left corner of mouth (arrowhead).

Studies of short-term intubation have shown about a 6% incidence of laryngeal injury. A large majority of these injuries consists of submucosal hematomas. Mucosal laceration is infrequent. The development of these lesions appears related to the degree of patient relaxation, the presence of anatomical difficulties, and the experience of the medical personnel in performing the intubation (214,222).

Misplacement of endotracheal tubes (right mainstem bronchus, piriform sinus, esophagus, brain through a basal skull fracture) has been described (211,212,223).

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