Aspiration following a cave-in.

Reported is a case of massive aspiration of particulate matter after a cave-in. A 14-year-old boy was buried beneath 18 inches of dirt while playing at a construction site. After extrication he was breathing spontaneously and was transported to the emergency department on supplemental oxygen. Physical examination revealed cough, tachypnea, and diminished breath sounds of the right lung field. Chest radiographs showed multiple radiopaque densities filling the right mainstem bronchus and a left-to-right shift of the mediastinum. The patient was treated with bronchodilators followed by postural drainage and percussion. Chest radiographs and physical examination both returned to normal within 24 hours. Reports of massive aspiration of sand are scarce, and have emphasized the need for bronchoscopic removal of particles to restore ventilation. This case was managed with bronchodilators and postural drainage alone, with complete resolution of pulmonary abnormalities.