Sometimes foreign objects are difficult to figure out, sometimes they are pretty obvious. This one was somewhere in the middle.
In a prior MM, we discussed how a sudden onset of symptoms should make an evaluating SLP suspicious of a foreign object… however, this patient had a different story. He had an ng tube placed during a prolonged intubation. Had recently begun to improve medically, the SLP was trialing thin water with the patient for about a week, with coughing and throat clearing response noted inconsistently. A couple days before the MBS was scheduled, the coughing and throat clearing became more consistent-this was the only real change noted clinically.
Our Columbus market SLP arrived, and with the first view, knew that something was a little problematic. The ng tube had become coiled in the pharynx. You can see that the lower edge of the loop is actually nestled right into the valleulae. Our team immediately notified the facility staff. Coiling of the ng tube doesn’t happen all the time, but it’s not extremely rare. It can lead to respiratory distress, difficulty swallowing and even injury (after this happened, I read a horrifying account of an injury to the epiglottis of a patient with a coiled ng tube). Just one more circumstance to keep in mind when assessing a patient clinically.