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Bronchoscopy for specific situations
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Douglas Sidell, Christopher T. Towe, MyMy C. Buu
Rigid versus flexible bronchoscopyFlexible bronchoscopy allows for selective intubation and bronchial blockade as described. It allows for the identification and potential management of slower-flow distal segmental bleeding sources.Flexible bronchoscopy is limited by the diameter of the suction channel and may not provide adequate visualization during large-volume brisk bleeds (Video 9.10).Rigid bronchoscopy is often safer and is more effective at clearing blood and clot from the airways. It allows for simultaneous ventilation and has superior optics. The telescope can be removed and cleaned without removing the ventilating bronchoscope. A large suction catheter can be passed via the ventilating bronchoscope (Figure 9.3), and a flexible bronchoscope can be passed via the lumen of the rigid ventilating bronchoscope (hybrid approach), if needed.Rigid bronchoscopy can bypass or tamponade bleeding sources in the setting of large-volume bleeds such as tracheo-vascular fistulae. Rigid bronchoscopy allows for bronchial blocker placement while maintaining control of the airway and concurrently suctioning active bleeding during the procedure.
Meeting personal needs: hygiene
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Assist the person to rinse the mouth thoroughly with the chosen mouthwash solution, or use a rinsed toothbrush to do this if they are unable. Suction can be used to remove excess fluid from the mouth if they are unconscious, or have dysphagia (swallowing difficulty), as it is essential to prevent choking or aspiration of fluid (Jones 1998). A conscious person who is nursed flat, for example, after a spinal injury, can use a straw to suck fluid into the mouth to rinse and to spit through afterwards.
Maxillofacial Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Even with good suction, blood accumulates in the back of the throat and may obstruct or compromise the airway. Raising the head of the bed will reduce the venous pressure at the skull base and hence reduce bleeding. The application of pressure to bleeding within the nasal passages is also effective. Anterior and posterior nasal packs may be inserted. Alternatively, as discussed earlier, Foley catheters can be passed through each nostril until they are visualized behind the soft palate, after which the catheter balloon can be inflated and pulled forwards to impact in the nasopharynx. The Epistat™ device has anterior and posterior balloons, which can be inflated to apply pressure to the anterior nasal cavity as well (Figure 14.5). If the maxilla is very mobile, the nasopharyngeal balloons or packs may simply press the maxilla downwards opening the fracture, rather than apply pressure to the skull base. If this happens, it may be necessary to apply upwards pressure to the maxilla using bite blocks.
Inferior and Central Mound Pedicle Breast Reduction in Gigantomastia: A Safe Alternative?
Published in Journal of Investigative Surgery, 2021
Fatma Bilgen, Alper Ural, Mehmet Bekerecioğlu
The pedicle was designed, with a base width of 10–12 cm on the inframmarial fold and 2 cm margin around areola. Areola diameter was prepared 4 cm. Afterwards, the inferior pedicle was de-epithelialized meticulously in order to avoid thinning of the dermis especially at the pedicle base. Medial and lateral dermoglandular resections were performed above the level of pectoralis fascia as standard. The superior skin flap was released to the level just below the clavicle and upper quadrants were undermined adequately. The pedicle base was kept wide enough over the area where it attaches the pectoralis fascia posteriorly. The pedicle was anchored to the level of fourth rib with two interrupted 2-0 vicryl sutures. The NAC was transferred to its new areola hole without any tension (Figures 2 and 3). Suction drains were used in each patient routinely. Most of the drains were removed on the postoperative second day. The subcutaneous tissue and skin were closed in two distinct layers with absorbable monocryl sutures. The patients are advised to apply silicone sheets and wear a full time bra for 2 months.
Inferior Vena Cava Diameter is an Early Marker of Central Hypovolemia during Simulated Blood Loss
Published in Prehospital Emergency Care, 2021
Blair D. Johnson, Zachary J. Schlader, Michael W. Schaake, Moragn C. O’Leary, David Hostler, Howard Lin, Erika St. James, Penelope C. Lema, Aaron Bola, Brian M. Clemency
Lower body negative pressure (LBNP) is a validated, noninvasive surrogate of progressive blood loss in humans that can be used to study a variety of physiological responses to hemorrhage (7–10). During LBNP, the lower half of a participant’s body is sealed to an airtight chamber (Figure 1). The pressure within the LBNP chamber is controlled using a voltage-regulated vacuum. When suction is applied. LBNP sequesters circulating blood volume in the lower extremities to induce central hypovolemia that can be quickly restored when the technique is terminated. In this regard, LBNP can safely elicit cardiovascular decompensation in human participants (11), whereas the amount of blood volume that can be safely removed from human volunteers in the laboratory is limited. The objective of this study was to test the hypothesis that ultrasound measurements of IVC diameter would decrease during simulated severe hemorrhage using LBNP.
The COVID-19 pandemic
Published in Critical Reviews in Clinical Laboratory Sciences, 2020
Marco Ciotti, Massimo Ciccozzi, Alessandro Terrinoni, Wen-Can Jiang, Cheng-Bin Wang, Sergio Bernardini
If the respiratory distress and/or hypoxemia cannot be relieved, high-flow nasal cannula oxygen therapy or noninvasive ventilation should be used. If the condition of the patient does not improve or if it worsens within 1–2 h, tracheal intubation and invasive mechanical ventilation should be performed. Sedation and muscle relaxants should be used for patients who have a problem with man-machine synchronization. Closed sputum suction should be considered according to airway secretions. For patients with severe acute respiratory distress syndrome (ARDS), lung expansion is recommended, and prone ventilation should be performed for more than 12 h every day. If it is not effective, extracorporeal membrane pulmonary oxygenation (ECMO) should be considered. The indications of ECMO are as follows: (1) when FiO2>90%, the oxygenation index is less than 80 mmHg for 3–4 h; (2) patients with simple respiratory failure with plateau ≥35 cm H2O, the VV-ECMO mode is selected; if circulatory support is needed at the same time, the VA-ECMO mode is preferred. Weaning off ECMO can be considered when the underlying disease is under control and cardiopulmonary function shows signs of recovery [116,117].