Comments on: PHARM Podcast 53: #FOAMEd Online Airway training Program – Airway Decision making

By: rfdsdoc

rfdsdoc — Wed, 17 Apr 2013 10:35:08 +0000

great tip, thanks!

By: Tor Pedersen

Tor Pedersen — Wed, 17 Apr 2013 09:52:33 +0000

A simple test for tube occlusion I devised after a scary in incident as an intern, a case that kind of reminds me of this one. I was on call alone at a tiny rural hospital – an intubated patient became impossible to ventilate over a few minutes, at the time I reasoned that it was either the lungs or the tube, if it was the former the patient was f***ed anyways, but if it was the latter then removal of the tube would be lifesaving. So I did, and turned out the tube was occluded with thick mucus, so thick that nothing could be aspirated.

Well afterwards I figured out a simple test for “tube vs lungs”: Deflate the cuff, if it then becomes easy to bag, but air leaks out then it is the lungs. If it is still just as difficult to bag then it is the tube…

By: Sean Marshall

Sean Marshall — Wed, 26 Dec 2012 18:49:48 +0000

Great learning case. I dealt with something similar in ICU a couple weeks ago… a partially dislodged tracheostomy tube and difficult intubation features. Quite challenging.

One thing I’d like to add to the discussion, which I think Minh aluded to, is in this case presentation with neck radiation plus an unusual tracheostomy tube, one should consider whether this may be a laryngectomy stoma rather than a standard tracheostomy. The implication being that if you obtain that piece of info in the history the option of intubation from above is completely off the table, there’s no physical connection to the trachea from above in these patients.

Merry Christmas!