We are now performing a bronchoscopy on a patient who has been electively intubated for foreign body retrieval. This patient developed severe coughing fits while eating trail mix, and as we can see here has a peanut wedged in their bronchus intermedius. As we think about options to retrieve the peanut, we are aware that cryo-extraction will be unsuccessful as the peanut is without water as a substance to retrieve it. A forceps is also likely to crumble the peanut if we try to retrieve in that fashion. We also now notice that there is a large raisin potentially obstructing the distal left mainstem and into the left lower lobe. An ideal retrieval tool for the peanut is potentially a basket such as a spiral wire basket. Basket please. There is no granulation tissue. So we'll likely be able to pass the basket easily around the foreign object. It's important to use closed loop communication with your assistant for these procedures as the timing of insertion and retrieval will be key to your success. Open. Basket open. And close slowly. We want to assure that the three wires are located around the object almost circumferentially, which we did not succeed on the first attempt. Basket in. Basket in. Basket out. Basket out. You can observe the rotatory move of the wrist. And flexing the tip of the scope upwards. And I'll close the basket slowly. Ready? And once we realize that we have a secure connection between the basket and the foreign object, we remove the basket and the foreign object on block while trying to avoid touching the airway wall. Our patient has been intubated with a large endotracheal tube, so the hope is that we would be able to retrieve this object through the tube. However, if that was not possible, it would be important to have a backup plan for airway management. Disconnect the ventilator. Emphasize the basket. And remove the foreign object. Close the basket. Reconnect the ventilator. We will now perform an airway inspection and retrieve our remaining foreign bodies. We're quickly re-inspecting the bronchus intermedius, where the peanut was, and we are not seeing any residual foreign object. A very small piece, which was easily aspirated. And we're cleaning the lens, and then we'll go and remove the resin from the lens. Let's go and remove the resin from the left main bronchus. The resin appears quite large, so this may be a situation where we would need to extubate the patient and re-intubate to re-secure the airway after removal. Red tooth forceps, please. Be aware for the red tooth forceps, it's better to use a therapeutic scope. Open. Rotate counterclockwise slightly. Counterclockwise. Perfect. Close. And again, we're removing forceps and foreign object on block. Give a deep breath and hold. And we're retrieving the object, again avoiding trauma to the wall. And in this case, it does seem that the resin is larger than the tip of the tube, so rather than lose it here, we decide to remove forceps, resin, and ET tube on block. Deflate the cuff. Cuff is down. Disconnect the ventilator. And we're removing on block. Advance forceps. Open forceps. Open. Close forceps. Close. Forceps out. We will now proceed with the flexible fiber optic intubation and reversal of anesthesia.

bronchoscopy

intubation

peanut removal

spiral wire basket

raisin removal