The presence of a tracheostomy tube can adversely effect swallowing: in patients who previously had no dysphagia; and further impair swallowing function in those who already have neurological or mechanical disorders of swallowing.
fenestrated tracheostomy tube. allows patient to breath normally with a tracheostomy in situ. patient can cough and speak through mouth. improves swallow function. acts a step prior to decannulation
Tracheostomy is performed in critically ill adults requiring prolonged invasive ventilation as a strategy to: — reduce respiratory tract injury — improve patient comfort, and/or — to facilitate weaning
Is this tracheostomy patient ready for decannulation? Hot Case
Ventilator management should be aimed at getting the patient off ventilator support as rapidly as possible. Weaning can be considered once the underlying process necessitating mechanical ventilation is resolving
Mephedrone is a new stimulant drug being abused on the street, and has recently been discovered in Australia. The following review provides emergency clinicians with assessing managing patients under the influence of mephedrone.
Tracheostomy is an airway that is inserted subglottically through neck tissues directly into the trachea. Surgical Tracheostomy involves dissection and incision of trachea under direct vision.
Weaning from ventilation = Multi-factorial and list headings of causes -> clinical signs associated with list: Hot Case
Tracheostomy, advantages and disadvantages. Pro: reduced sedation requirement (greater comfort than oro-tracheal intubation). Con: requirement for a surgical procedure with inherent risk of complications
Approach to percutaneous dilatational tracheostomy (PDT) procedure
Summary of evidence for PDT versus open tracheostomy. No difference in ICU or hospital mortality; duration of ventilation; nosocomial pneumonia
Percutaneous tracheostomy = reference to a number of different techniques to insert a tracheostomy (gradual dilation, forceps dilation, rhino and translaryngeal techniques)