Differential Diagnosis for Hypoxia after Intubation with Bleeding during Intubation

• Single most likely diagnosis:
  • Aspiration of blood: This is a common issue when there is bleeding during intubation. The blood can be aspirated into the lungs, causing hypoxia due to impaired gas exchange.
• Other Likely diagnoses:
  • Mainstem intubation: If the endotracheal tube is placed too far and enters one of the mainstem bronchi, it can cause hypoxia by ventilating only one lung.
  • Pneumothorax: The process of intubation, especially with bleeding, might lead to barotrauma or direct injury to the lung, resulting in a pneumothorax, which can cause hypoxia.
  • Pulmonary edema: The stress of intubation and possible fluid shifts can lead to pulmonary edema, impairing gas exchange and causing hypoxia.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Esophageal intubation: Although less likely if the tube is confirmed to be in the trachea, esophageal intubation can still occur, especially if there was difficulty with the intubation or if the tube has become dislodged. This is life-threatening and must be ruled out.
  • Tension pneumothorax: A more severe form of pneumothorax that can lead to rapid deterioration and death if not promptly recognized and treated.
  • Anaphylaxis: Although rare, anaphylaxis can occur due to the medications used during intubation or to the latex in the gloves or tube. It can cause hypoxia among other symptoms.
• Rare diagnoses:
  • Tracheal or bronchial rupture: Direct trauma during intubation can lead to rupture of the trachea or a bronchus, which is rare but can cause severe hypoxia and requires immediate surgical intervention.
  • Foreign body aspiration: If any foreign material (e.g., teeth, debris) is dislodged during intubation and aspirated, it can cause an airway obstruction leading to hypoxia.