气切导管故障.pdfVIP

Tracheostomy Tube Malfunction 20 Deena Bengiamin and Bharath Chakravarthy Tracheostomy tube (TT) malfunction is the source of airway • Saline compromise in patients requiring these airway devices. TT • N-Acetyl-cysteine (NAC) malfunction may create an airway emergency, and the timely • Appropriately sized endotracheal tube (ETT) or TT replacement of TTs is a challenging procedure in the most experienced hands. 20.3 Procedure 20.1 Indications 1. Supply high-fl ow humidifi ed oxygen through a bag valve mask (BVM), or a non-rebreather face mask. • Cuff rupture 2. Assess clinical indicators to determine TT problem. – Can lead to dislodgment (a) Indicators of cuff rupture: Air leak with BVM and • Dislodgment loose TT. – Most common emergency department TT (b) Indicators of dislodged TT (if TT is still in the stomal complication opening): Subcutaneous emphysema, crepitus, and – Can lead to air passage obstruction diminished or absent breath sounds. • Obstruction (c) Indicators of an obstructed TT: ±stridor and dimin- – Caused by blood or thick, dry secretions (formed in the ished or absent breath sounds. absence o