COCAINE BALLOON ASPIRATION - SUCCESSFUL REMOVAL WITH BRONCHOSCOPY

Ingestion of balloons containing illicit substances along with the pot ential toxic sequelae associated with these ingestions have been descr ibed in the literature. This report describes the successful bronchosc opic retrieval of a cocaine balloon after aspiration. A 39 year-old ma n was witnessed swallowing several balloons that were thought to conta in heroin. Shortly after ingestion, the patient became unconscious and required nasotracheal intubation, Before intubation, several balloons were removed from the oropharynx, Naloxone 4 mg was administered en r oute to the emergency department (ED). Following naloxone, the patient awoke and became agitated and combative, On arrival in the ED, midazo lam, succinylcholine, and vecuronium were required to manage his comba tiveness, Vital signs were: heart rate, 130 beats/min; blood pressure, 128/86 mm Hg; respirations, 12 breathslmin; temperature, 96.5 degrees F. A balloon and balloon tip were removed during ravage, Whole bowel irrigation with a polyethylene glycol electrolyte solution was initiat ed. A right upper lobe infiltrate was identified on chest X-ray and as piration of a balloon was suspected. At bronchoscopy, a small yellow, intact balloon visualized in the basilar segment of the right lower lo be was removed. Toxicologic analysis of the balloon contents found coc aine. The rest of the patient's hospital course was unremarkable and h e was discharged 5 days after admission. This case brings to light the potential concerns, such as respiratory compromise, associated with a spiration of small balloons in the body stuffer, Additionally, the pot ential for the development of toxicity if the balloon ruptures and tox in absorption occurs through the lungs should be considered. Emergency physicians and toxicologists should be aware of this significant comp lication of packet ingestion in the body packer or stuffer and be prep ared to intervene early during the course of the patient's treatment. (Am J Emerg Med 1997;15:544-546. Copyright (C) 1997 by W.B. Saunders C ompany).