If only medical or health care will teach this way. No need for “ you should already know this”. How refreshing that someone so accomplished as this MD humbly enough stated “didn’t encounter this as much”. Nobody stated “to blunt the end of tracheostomy tube to avoid fistula”. Simple to the fact and effective way of remembering a rationale. First couple mins and I’m hooked. Ty!
Thank you so much for this. I'm a home health nurse & I'm getting a vented trached patient who I will be watching at night while they sleep. This was super informative & I feel so much more comfortable now that I know this info.
1:18 - - (44 y/o OD’d on heroine in ER, PA arrest, prolonged resuscitation, severe anoxic brain injury) 1:10 - - 9 days s/p trach, *tachycardic,* “sick kipnuk”(?), severe respiratory distress, hypertensive 1:35 - - 110,000 tracheostomies performed annually in the US 1:43 - - 40-50% of trached patients will have a complication (most in ICU), most minor req minimal intervention 1:54 - - (1% of trached patients suffer a catastrophic airway complication) 1:59 - - *HALF of airway deaths in ER or ICU are due to DISLODGMENT or DECANNULATION*
Great review. I would add one note of caution against silo thinking by focusing exclusively on the tracheostomy in a hypoxemic patient. What if you run this brief algorithm but the patient does not improve? One other consideration in these patients is they are particularly susceptible to mucus plugs which can suddenly obstruct an entire bronchus. The airway will be clear but the patient's dropped a lung- acts like a PE but there will be absent breath sounds and a CXR will be whited out on that side. Identifying may be easier than fixing; you can try deep suction, mucomyst nebs, chest percussion, anything to knock the plug loose. Disclaimer- do not listen to me 🤘.
Great video, very helpful, thank you!! Question please: wouldn’t it make more sense to deflate cuff and reposition existing inner cannula as step 2, BEFORE removing the inner cannula and suctioning?
Thank you for this video. Can you please explain how a ruptured cuff wouldn't be signalled by the pilot balloon? Shouldn't that be something that stands out to the clinician? Just asking.
@@CriticalCareNow A leak slow enough to leave the balloon inflated shouldn't cause this type of decompensation and need for urgent tube exchange though. Just reinflate the cuff and they'll be fixed (temporarily).
Sister my brother now admit in ksa hospital doctor say can suggested with family i will fix the neck tube or u suggested me if no danger this then I will give the operation order please?
