Intubation Case Studies

A prospective, matched cohort study was conducted to evaluate the attributable morbidity and mortality of VAP in intensive care unit (ICU) patients. One hundred and seventy-seven patients developed VAP and stayed in the ICU for 4.3 days longer and had a trend toward an increase in risk of death

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

Oxygen can be a comforting, life sustaining treatment and a potent killer. As one of three components of the fire triangle (heat, fuel, and oxygen), it has the potential to cause great injury and even death in those who ignore the risks and fail to follow safety guidelines. The Joint Commission has identified the risk of medical oxygen home fires as serious enough to include it as the 2015 National Patient Safety Goal (NPSG) 15.02.01. It states a home care organization must “Identify patient safety areas: Find out if there are any risks for patients who are getting oxygen. For example, fires in the patient’s home.” (The Joint Commission, 2015). This work is a review of available literature on the issue, its link to nursing administration, the significance to quality and safe nursing practice, as well as potential opportunities for improvement and recommendations for strategies to improve the safety of patients, families, and nursing staff. According to 2003 – 2006 data from the Consumer Product Safety Commission’s National Injury Surveillance System, medical oxygen in the home was a factor in and average of 1,190 thermal burns seen annually in U.S. emergency rooms (Galligan, et al., 2015). Smoking is the leading cause in these incidents and several studies suggest that the incidence of burn

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

Data: Pulmonary function testing dated 2010 showed moderately severe obstruction with positive bronchodilators response. Normal lung volumes. Evidence of air trapping. Severely reduced diffusing capacity for carbon monoxide.

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

On the early morning of August 17, 2002, James C., a patient in one of the wards under the supervision of Ellen Hughes Finnerty, RN, went into respiratory depression. Between 3:00 and 4:00 a.m., Ann Mugi, the patient’s primary nurse, sought the assistance of a respiratory therapist, Hiran Obeyesekere, to help her care for the patient. As Obeyesekere suctioned the patient airway, Mugi called the service of the patient’s primary care physician, Dr. Jackson, to report the changes in the patient’s respiratory status, e.g., respiratory rate of 40 breaths per minute and low urine output.

A cousin of mine, Susan, approached me after her father received open heart surgery. Susan’s father, age 59, has been a chronic smoker since the age of 19. What went from two cigarettes a day quickly become two packs a day, with no end in sight. During July of 2015 he complained of feeling dizziness, shortness of breath,

HISTORY OF PRESENT ILLNESS: David Lockman is here for followup for his traumatic saw injury to his right knee. He is about two and half weeks out now. He was seen, I believe a week or so ago or two weeks ago perhaps, by one of my partners. He was sent for therapy, although he has had some delay in therapy. He just started therapy. He did get a blood clot, I believe recently, and is now on Xarelto for that. He states that the swelling in his leg is much better, at this point. He does continue to smoke, however. I believe he is a half a pack or one pack per day smoker. Again, I went over smoking cessation with him, as well as the risks of uncontrolled bleeding with the Xarelto that he currently on. He understands this, so he should

The incident happened on Nov 21st, 2017. The patient has sleep apnea and a health history of chronic bronchitis (no episode in recent 2 years). Her respiration rate was 16 and all lung fields were clear upon auscultation. After I took the patient’s vital signs, I noticed that her oxygen saturation was low (83%). Then, I notified the nurse and asked the patient to do take some deep breath. After that, we put her on 2L of oxygen and her oxygen saturation went up to above 90s. However, the patient had a bladder control problem (was incontinent), so I took the oxygen off because she went to the toilet for around 4-5 times in an hour. However, I forgot to monitor her O2 saturation right away. Instead, I checked her oxygen saturation after she finished her dinner, and it dropped to 86%. The instructor showed me how deep breathing exercise can help the patient increase her oxygen level quickly. I notified the nurse and we put the patient on 2L of oxygen, but again I forgot to check her oxygen saturation right away. Instead, I checked her oxygen around 7pm later.

Inhalation injury is the leading cause of death in fire victims. It is estimated that half of these deaths could have been prevented with use of a smoke detector. Often, burn victims make it out of a burning home safely. However, once they are outside, they may realize that their loved ones, pets, or valuable items are still inside the burning home. They then re-enter the burning home and are overcome with toxic smoke and fumes and become disoriented or unconscious. Inhalation injury has a significant impact on survivability of a burn patient. Deterioration in severely burned patients can occur without evidence of a smoke inhalation injury.

➢ The patient may have no respiratory problems, but may still have inhaled carbon monoxide.

At today’s visit he is accompanied by his daughter. He is awake, alert and oriented times2. He denies pain and shortness of breath. His daughter reports that a couple weeks ago he was diagnosed with pneumonia and was having more shortness of breath and using his oxygen all the time. She states that the patient condition has improved drastically and that he only uses the oxygen now at night and does not have shortness of breath with rest. The patient also uses nebulizer as needed. He reports a great appetite, and that he is feeling well. He ambulate without assistance and able to perform his ADLS by himself. No acute distress noted at this time. Goals of care discussed the daughter states that when patient is hospice appropriate, she would

Pulse oximetry reading could not be recorded by standard finger probe. Ear lobe pulse oximeter showed room air saturation of 95% with weak tracing and poor plethysmograph. Patient was administered general anaesthesia, using injection fentanyl 100 µg, injection propofol 100 mg. The airway was secured using laryngeal mask airway supreme No. 3. No improvement was seen in the ear lobe tracing post anaesthesia. The probe was then placed on lingual surface of tongue, as shown in the picture. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane, the case was continued using glossal pulse oximetry monitoring which was switched back to ear lobe prior to removal of supraglottic device. Rest of recovery was