A case of ingested laryngoscope bulb during emergency endotracheal intubation.

Sir,

We report a case of 68-year-old female who presented to emergency department with dyspnea. We decided to intubate in view of decreasing saturation and increased work of breathing. During laryngoscopy, the light of the laryngoscope bulb was not seen clearly and was considered to be due to poor battery quality. The patient was intubated immediately using another laryngoscope. On proper examination of the previous laryngoscope, the bulb was found to be missing. Radiological examination revealed laryngoscope bulb in the stomach of the patient [Figure 1]. Consultation with an experienced gastroenterologist was sought, and an emergency endoscopy was done which failed to retrieve the bulb. Gastroenterologist opined for a conservative management. After 3 days, the laryngoscope bulb was retrieved from the stool of the patient. The patient got discharged after 7 days.

Figure 1

X-ray showing laryngoscope bulb in the stomach

Airway management in critical care is potentially more difficult and more likely to be associated with complications.[1] Few cases have been reported in which the bulb or other part of a laryngoscope was aspirated or swallowed. Ince et al.[2] and Naumovski et al.[3] reported ingestion of laryngoscope bulb in neonates. Thapa et al.[4] reported a case of lost laryngoscope bulb in a neurology patient during endotracheal intubation. Sklar and Tandberg[5] reported a case of ingestion of broken glass of laryngoscope bulb in patient with seizure.

This case is another example among the few existing literature that signifies the importance of proper checking of the integrity of airway equipment both before and after its use. We are fortunate in that the incident was recognized immediately and the laryngoscope bulb was swallowed rather than aspirated. Every effort must be made to find the lost laryngoscope bulb. X-ray of the chest and neck should be taken if the lost bulb cannot be found in the oral cavity. This incident also signifies the importance of the availability of second laryngoscope in cases of emergency intubation.

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