Archive for April 2011
The cabbie had a STOMA
April 25th, 2011 | 
Author In case anyone was wondering, here are wikipedia’s instructions for how to perform a tracheotomy… Curvilinear skin incision along relaxed skin tension lines between sternal notch and cricoid cartilage. Midline blunt dissection down to the trachea (optional depending on technique). Insertion of 14-gauge plastic cannula and needle with fluid filled syringe attached into trachea. Aspiration of air confirms correct placement of the tip in the trachea. Removal of needle leaving cannula in place. Insertion of soft tipped guide wire into trachea through cannula. Removal of cannula leaving guide wire in place. Tracheal dilatation is now undertaken – different techniques do this in different ways. Ciaglia – the sequential insertion and removal of a series (usually 4-5) of increasing larger dilators over the wire into the trachea. Griggs – insertion of a specially designed pair of guide-wire forceps along the wire into the trachea and then are opened to complete the dilation in one step. Rhino – insertion of a single large tapered dilator over a plastic guidewire reinforcement. Frova Percutwist – insertion of a specially designed screw of increasing diameter which rotates to create the dilatation. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures. Connect ventilator tubing.
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how to choose your appropriate endotracheal tube
If you are in general anesthesia,which assistant device you want to choose.In many cases of general anesthesia, a device known as an endotracheal tube is inserted into the patient’s windpipe to assure that it remains open and functional. This procedure carries its own risks, though. If the tracheostomy tube slips into the patient’s esophagus instead of trachea (windpipe), it will not deliver oxygen to the lungs, and the person will quickly suffer the grave consequences discussed in the previous paragraph. Also, if intubation is attempted and failed multiple times, trauma to the airway can cause swelling or obstruction, and seal the lungs off from the air they need. If this happens, an emergency tracheotomy must be performed, in which a hole is cut in the airway, allowing air to bypass the obstruction.
When a person under general anesthesia, they completely unconscious and temporarily paralyzed This means that in addition to the risk of a bad reaction to the powerful drugs used in this process, there is the added danger of the patient’s body being partially shut down during the procedure. Regular necessary functions, such as breathing, must be carefully monitored to assure that the person’s wellbeing protected. In fact, airway management(laryngeal mask airway) is one of the main areas where anesthesia complications have the potential to leave a patient permanently injured or even dead.
In just 4 minutes of oxygen, a person’s brain can be irreversible damage; from them what is commonly referred to as “brain dead.” In the next few minutes, the body can continue to close, in cardiac arrest, leading to death. Therefore, it is clear that surgical patients to ensure safe maintenance of oxygen supply(by oxygen mask) should be one of the main problems of narcotic.Ventilator was used to ensure the exchange of carbon dioxide gas in a person’s lungs can continue to function normally under anesthesia, they are. If it is misused or ventilator failure, however, this exchange does not occur properly, leading to hypoxia (oxygen shortage), or if you create too much pressure on a hole in the lung development.Although they are terrible, these threats are very real. General anesthesia is not a program, guard, medical professionals have a responsibility to ensure the safety of patients while they are unconscious. If a doctor’s negligence caused the injury or death of the anesthetized patients, they may face the medical litigation, and to pay compensation to the victim.
Originally published here.
ericfu
Endotracheal Tube
An endotracheal tube (also called an ET tube or ETT) is used in general anaesthesia, intensive care and emergency medicine for airway management, mechanical ventilation and as an alternative route for many drugs if an IV line cannot be established. The tube is inserted into a patient’s trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. The endotracheal tube is regarded as the most reliable available method for protecting a patient’s oxygen mask .
Types of tracheal tube
Types of endotracheal tube (ETT) include oral or nasal, cuffed or un-cuffed, preformed (e.g. RAE tube), laryngeal mask airway, double-lumen tubes and tracheostomy tubes. For human use, tubes range in size from 2-10.5 mm in internal diameter (ID). The size is chosen based on the patient’s body size, with the smaller sizes being used for paediatric and neonatal patients. Tubes larger than 6 mm ID usually have an inflatable cuff.
Endotracheal tube
Originally made from red rubber, most modern tubes are made from polyvinyl chloride. Those placed in a laser field may be flexometallic.
Dr. Robertshaw (and others) developed double-lumen endo-bronchial tubes for intra-thoracic surgery. These allow single-lung ventilation whilst the other lung is collapsed to make surgery easier. The deflated lung is re-inflated as surgery finishes to check for fistulas (tears).
Another type of endotracheal tube has a small second lumen opening above the inflatable cuff, which can be used for suction of the nasopharngeal area and above the cuff to aid extubation (removal). This allows suctioning of secretions which sit above the cuff which helps reduce the risk of chest infections in long-term intubated patients.
A shortened tube, a tracheostomy tube, can be inserted through an opening in the neck (a tracheostomy) into the trachea. This is often a temporary stoma, but patients can live with them permanently.
Originally published here.
panbrian