Download Bedside Procedures in the ICU by Christiana C. Burt, Jurgens Nortje (auth.), Florian Falter PDF
By Christiana C. Burt, Jurgens Nortje (auth.), Florian Falter (eds.)
This guide is a advisor to most sensible perform in interventions often encountered within the ICU. it truly is clinically oriented delivering :step-by-step motives and illustrations of such a lot invasive strategies, money lists to ensure the indication is correct, money lists to make sure acceptable evaluate as soon as the approach has been performed. the knowledge is definitely obtainable delivering functional recommendation and crucial history for each member of the multi-disciplinary workforce taking care of severely ailing sufferers. it is going to serve the senior advisor who has no longer played a technique for it slow in addition to the junior medical professional wanting an aide memoire.
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Additional resources for Bedside Procedures in the ICU
2 Anatomy of the neck and incision site for tracheostomy Positioning and Identification of Site • The patient is positioned supine with the neck slightly extended – placing a rolled towel or bag of fluids under the shoulders and removing the pillow is usually sufficient. − Over-extension of the neck can result in a low tracheal puncture and a tracheostomy too close to the suprasternal notch. • The operator has to identify the landmarks of the anterior neck, confirming the midline positions of the thyroid cartilage, crico-thyroid membrane, cricoid cartilage, proximal trachea and supra-sternal notch (see Fig.
PDT is not a procedure for a single operator. The team has to comprise of − One operator for the PDT − One endoscopist, who is also proficient in airway management and manipulation, for the bronchoscopy. − One support staff (often a nurse), familiar with the equipment and the procedure. • Immediate availability of airway equipment is mandatory (see Chap. 2), as urgent orotracheal re-intubation may be required. • Adequate lighting is essential. • An appropriate selection of different sized tracheostomy tubes needs to be available.
Overall FOB is a safe procedure, which is generally well tolerated with very few major complications. • Patients who are not already ventilated are at risk of deteriorating respiratory function during the procedure. Some patients might even require intubation and mechanical ventilation • The risk of worsening hypoxemia and subsequent arrhythmia is associated with sedation • Throat discomfort • Vocal cord injury • Epistaxis, if the procedure is performed via the nose in awake patients • Patients requiring airway intervention have the additional risk of − Bleeding (1–5%) − Pneumothorax (5–10%) Preparation The safe conduct of a bronchoscopy in critically ill patients requires careful preparation and attention to detail.