Critical Care

Tracheostomy Emergencies

A 44-year-old man with a history of cardiac arrest complicated by hypoxic-ischemic encephalopathy presents to the ED in respiratory distress. He underwent tracheostomy 2 weeks ago for acute respiratory failure and was subsequently weaned to trach collar. He developed acute onset of respiratory distress at rehab this morning and now presents to the ED with acute hypoxic respiratory failure. On exam, he is hypertensive (169/88), tachycardic (HR 178), tachypneic with respirations assisted with bag-valve mask (BVM) ventilation and hypoxemic (SpO2 87%). What is your approach to the management of tracheostomy emergencies?

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Mechanical Ventilation Alarms: High Airway Pressure

You are called to the bedside of a mechanically ventilated patient for an alarm that is being triggered on the ventilator. In red and blinking you see “Airway pressure high.” What’s your next move?

 

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Ventilator graphic analysis: Obstructive lung disease

Analyzing ventilator waveforms in a patient with acute respiratory failure is as essential as monitoring the telemetry of a patient with suspected cardiac dysrhythmia. What life-threatening complication is demonstrated in the ventilator graphics? 

 

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Pressure regulated volume control (PRVC): Is it a “volume control” or “pressure control” breath?

Dr. Phil Dellinger, master of mechanical ventilation, breaks down Pressure Regulated Volume Control (PRVC) by discussing the breath type delivered in this mode of mechanical ventilation.  

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