Recently in Endotrachial Intubation Category

November 6, 2012

Endotrachial Intubation

It is a medical procedure in which a tube is placed into the trachea to open the airway, remove blockages and to provide oxygen, medication or anesthesia. It may be attached to a machine called a respirator that will breathe for the patient while the tube is still in place. Airway control and mechanical ventilation are often necessary in the treatment of severe burn injuries.

Swelling in the upper airway is a major concern in any person with a burn injury. Swelling may lead to acute respiratory insufficiency, in children the airway is smaller therefore they are more prone to develop airway obstruction from burn. Swelling and damage to the airway may be caused by inhalation of the gases and fumes caused by combustion and/or the effect of heat on the tissue (see smoke inhalation). The extent of the damage to the airways is not directly related to the severity of skin burns and in some cases it may become the greatest therapeutic problem in a gravely burned patient.

Although obstruction of the upper airways caused by edema (swelling of the tissue) may happen acutely, it may not be present until the edema is sufficient enough to produce clinical evidence of impaired airway patency which may take 12-18 hours. Therefore it is important to monitor the patient for any difficulty in respiration even though the patient may not have any problems initially.

Extensive face and neck burns increase the risk of airway compression and the need for early endotracheal intubation. Deep face burns may lead to airway obstruction due to intraoral edema which will in turn decrease the clearance of intraoral secretions and impair the protection of the airway from aspiration. Deep neck burns will increase the risk of airway compression and the need for early endotracheal intubation due to the external compression of the larynx by the swollen neck.

A decision will be made by the treating physician after initial assessment as to whether or not the airway can be managed safely without an endotracheal tube. The treating physician will also make the determination of how long the patient will be intubated and when the tube is taken out depending on the condition of the patient.

When the patient is intubated, he/she may stay in bed for a prolonged period of time, this may increase the risk of developing Deep venous thrombosis (see Deep venous thrombosis part I, II) which is the main cause of pulmonary embolism, these patients are given prophylactic measures to decrease the risk of deep venous thrombosis (medications and compression devices). Make sure that these devices are worn all the time and if they are disconnected (to walk or visit the restroom), make sure that they are reconnected when the patient returns to his/her bed.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

January 20, 2011

Putting Out Fires Yourself: A Recipe for Third-Degree Burns

In my previous post two days ago, I wrote about the need to be aware of fire hazards not just inside your home, but surrounding your home as well. The reason: Careless neighbors can cause a fire that spreads to where you live too. Such a situation nearly happened to me not long ago, and my neighbor almost got burned badly because she tried to put the fire she started rather than calling firefighters to let them do it.

Sure enough, a story appeared in a London newspaper the next day, January 17, about a British man there who did the same thing as my neighbor. Unfortunately, that man now has third-degree burns and smoke-inhalation injuries to his lungs that threaten his life. Here is part of that article:

"A man barely escaped with his life after an early-morning fire Monday in an apartment in London's east end. The man was cooking and likely fell asleep, only to be woken up by his smoke detector. 'He tried to put the fire out himself but sustained burns to his face, his forearms, and hands, plus he suffered some smoke inhalation,' district chief Jeff Adams reported."

"Although the man was conscious and talking when firefighters arrived, paramedics consider his injuries life-threatening because of the facial burns and smoke he inhaled. Adams said, 'I think 50 percent of people would try to put out the fire, but you have to be very careful. We like to tell people to close the door and let the professionals handle it.'"

"Most of the damage was to the kitchen -- the stove, the cupboards above the stove and the wall, plus there was smoke damage throughout."

Even so, another tenant of the eighth floor of the apartment complex says that he saw smoke coming from under the door, and that he was the one who called authorities for help. By the time firefighters arrived, the fire was mostly out--but smoke had filled the entire hallway. This means that sleeping neighbors were at risk for dangerous smoke inhalation too, and might not have woken up in time to get out.

The lesson here: The greatest home-fire threat to you might actually be outside your home. So monitor your home's surroundings occasionally for things that could start or accelerate a fire.

And the day before this London fire took place, a house caught fire in Springfield, MO due to something that most of us would never even think about: An extension cord connected to a space heater shorted out, igniting clothes that were laying on the cord. Now, having clothing laying around is not a rare situation in many homes, including mine. But if you just take a moment and think about where you're setting those clothes or any other flammable item, you can avoid a dangerous situation.

In this case, two young girls were rescued from the home, one of them thanks a thermal-image camera that lets firefighters see through the smoke. Still, the girls suffered burns and smoke inhalation, as did one of the firefighters.

See the full article here.