tag:blogger.com,1999:blog-2722509310767947398.post7453908187709311728..comments2024-02-27T21:32:04.260-08:00Comments on KI Doc: Tracheal TraumaTim Leeuwenburghttp://www.blogger.com/profile/02071386260651236300noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-2722509310767947398.post-33070547827921016522012-01-05T14:24:58.456-08:002012-01-05T14:24:58.456-08:00Hi Tim
great discussion topic! In my mind, when yo...Hi Tim<br />great discussion topic! In my mind, when you are in a limited resource setting, say your small rural hospital, with this type of injury, yuo should approach it in terms of a double setup. There should be a provider each and preferably and airway assistant for each provider! Depending upon the injury you may choose to make one attempt orally with the second team set to access the neck if need be. Even if you decide to go through the neck, you need a team at the mouth to try to provide some support using BMV for example. Awakw techniques in low resource settings by novice providers are risky. If you are good at rSI and oral intubation, a double setup approach is probably your best shot. The awake surgical airway under local is also a reasonable plan but has its own risks. <br />One colleague had to deal with a traumatic tracheal transection due to a nasty farming machinery injury where the guy was spun around at high speed by his shirt collar. The doc luckily chose to fly in with an anaesthetist friend and they both decided to proceed with a doubel setup RSI. The patient had a very swollen neck with subcut emphysema already. The RSI oral intubation failed as they could not pass the ETT past the level of injury. The only thing that worked was BVM oxygenation incredibly! A needle cric failed, and as they were doing the open surgical cric, the patient started to crash his SaO2!! It took the HERO INCISION, floor of mouth to sternal notch cut to find the transected trachea proximally within the upper mediastinum and pass a bougie down it. Somehow they managed to pass a small ETT over the bougie and voila could ventilate the lungs! The patient made a full recovery after formal surgical repair and ICU stay!rfdsdochttps://www.blogger.com/profile/13919495080954427480noreply@blogger.comtag:blogger.com,1999:blog-2722509310767947398.post-17335320897656006672011-12-28T08:25:02.329-08:002011-12-28T08:25:02.329-08:00Disassociated awake with ketamine 0.5-1mg/kg. Pati...Disassociated awake with ketamine 0.5-1mg/kg. Patient will keep breathing, but will let you do what you need to do. Slip a cannula with o2 at 15 lpm down the defect and then stop gather resources and figure out what to do next.Scotthttp://emcrit.orgnoreply@blogger.comtag:blogger.com,1999:blog-2722509310767947398.post-87708069975625698822011-12-28T00:11:51.611-08:002011-12-28T00:11:51.611-08:00I'm merely an EMT from the states, but if you ...I'm merely an EMT from the states, but if you were electing to do a non-crashing cric/trach, a little ketamine would seem like a nice complement to the local in a patient who is anxious or combative and doesn't want to lay flat (which I imagine would be almost anyone with a severe tracheal injury). Not having to perform such a task myself, I'm curious what you or other docs think of such an approach.<br /><br />Thanks for the quality blog, I always enjoy your posts.<br /> - Vince DAnonymousnoreply@blogger.com