sedationstation

thoracotomy  for penetrating traumatic arrest; hysterotomy  for maternal cardiac arrest; surgical airway  for a can’t intubate, can’t oxygenate situation; limb amputation  for the entrapped casualty with life-threatening injuries; escharotomy  for a burns patient with compromised ventilation or limb perfusion; and  lateral canthotomy  for retrobulbar haemorrhage with orbital compartment syndrome.

A plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient’s ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications.

Neck extension assessment ... Place 1 finger on the patient’s chin and 1 finger on the occipital protuberance and extending the head maximally on the cervical spine. At full extension, if the chin remained lower than the level of the occipital protuberance, we considered extension to be limited.