By Christiana C. Burt, Jurgens Nortje (auth.), Florian Falter (eds.)
This guide is a advisor to top perform in interventions in most cases encountered within the ICU. it's clinically oriented supplying :step-by-step motives and illustrations of such a lot invasive methods, money lists to ensure the indication is true, payment lists to make sure acceptable review as soon as the technique has been performed. the data is well available supplying sensible suggestion and crucial historical past for each member of the multi-disciplinary group taking care of severely ailing sufferers. it's going to serve the senior advisor who has no longer played a technique for a while in addition to the junior surgeon short of an aide memoire.
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Extra info for Bedside Procedures in the ICU
Tracheostomy tubes (see Chap. 4) Indications • Maintaining airway patency in patients with a reduced level of consciousness or requiring sedation. • Airway protection in patients at risk of aspiration. • Prevention of complete airway obstruction. • Ventilation in patients with Type 1 or Type 2 respiratory failure. • Clearance of bronchial secretions in patients with poor cough. Preparation • Depending on the size and the layout of an ICU at least one airway trolley with intubation equipment (see Fig.
The decision whether or not to intubate and create a definite airway should not be delayed by much once mask ventilation has been started. • If the patient is not breathing a definitive airway will be needed, but temporary ventilatory support can be provided with a bag valve mask system attached to high flow oxygen until the patient can be intubated. Definitive Airway A cuffed tube in the trachea provides a definitive airway. • Orotracheal tubes (see Fig. 6) are sized according to internal diameter in mm, with sizes 7–9 most commonly used in adult ICU patients.
While obvious large veins will be avoided during the procedure, smaller ones may be torn during dilation. Firm pressure will usually be sufficient to 46 • • • • • R. Martynoga and C. Danbury stop bleeding from these small veins. The introduction of the tight-fitting tracheostomy tube will further compress any injured vessels. Hemorrhage into the airway is potentially serious as blood clots may cause airway obstruction. Catastrophic bleeding can occur if great vessels are lacerated during overly forceful dilatation.