Pneumothorax after a nasogastric tube

MICU. Patient’s family concerned with lack of nutrition in AOXZero meemaw after the ER had three failed attempts at a small bore nasogastric tube insertion. She came up to the ICU after steady decline after a SDH with dysphagia and encephalopathy shortly after Christmas.

The attending physician says “well Aaaaalright is the best at putting them in, shall we have him try?” He explains the risk and I give it a whirl. Everyone is watching.

I remove the stylet, lube it up, sit her up, and have another experienced nurse standing by with a syringe and stethoscope ready for an easy auscultation to confirm placement.

I drop it in, meet no resistance, patient does not cough when instructed and O2 saturations drop into the low 80’s on room air. 6L Nc brings her to 100%.

Chest XRAY arrives in less than two minutes. It’s in the right lung. 1 minute later the attending gets a phone call for a pneumothorax by general surgery.

5 minutes later general surgery arrives to place a chest tube. They place it. Meemaw is on room air again.

I drop another nasogastric tube.

Chest XRAY returns and confirms placement of chest tube and nasogastric tube.

All of this took place in under one hour.

The whole time i couldn’t stop thinking about the suppository I had brewing in the other room.

What a morning.

Edit: too many perforations from nurse insertions with the stylets in place so it’s a facility policy to remove them before.

Edit 2: I’m referring to a Dobhoff tube. They are listed as Small Bore Naso Gastric tube in my charting system so I used the generic term.

Interesting/goofy the DHT was invented by Dr. Robby Dobby and Dr. James Hoffmeister in the 1970’s.