What is your diagnosis?
Answer: This is a mediastinal mass. It is a malignancy until proven otherwise. For the geeks amongst you, the following are all possibilities. The first two are the commonest.
On arrival of the (fairly junior) ITU doctor the patient has a near respiratory arrest. It is night-time (of course) and the paeds anaesthetist is on their way in from home. The ITU registrar manages to pass an ET tube but appears completely unable to ventilate the child. With the child becoming increasingly cyanosed, is there anything else you could try?
Answer: You could try proning the child. This might just take some of the weight of the tumour off the tracheo-bronchial tree and allow you to get some air in. Passing the ET tube further in than usual may also help to bypass the obstruction. Send someone off to theatre to get kit (armoured tubes, double-lumen tubes etc) but do the above measures first – you might just save a life.
The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....