My Pt has a very bad hypoxic brain injury and brain aneurysm rupture. His GCS is only E1M2Vt1.
I spent all day to try to target his BP to MAP 65 with inoteopes up and down..
In the afternoon I noticed a pretty bad cuff leak and realised that he has bitten through the pilot tube, so we ended up need to do an urgent ETT exchange.
ETT exchange: ETT tube, 10mls syringe, lube, buggie, glidgo scope, portable EtCO2, Ambibag, ETAD, and medications.
We first use the scope to check the position, then deflated ETT and put the buggie down (bending end first and lube), then take the old ETT out, then put the new ETT in (lube), take the buggie out and inflate the cuff, then check EtCO2 and connected back to ventilator, then secured the ETT and check with CXR.
I got to do the airway role which is really good learning opportunities.
However pt SaO2 dropped after the cuff leak episodes and we suspected aspiration pneumonia from the feed. Luckily intense chest physio did help and we also increased his PEEP and put him on rate for a bit.
For the future I think I'll definitely remember to turn the feed off and try to aspirate if I have time.
I'm grateful for the learning opportunity today, it was very busy but learnt something new.
No comments:
Post a Comment