We just had a paramedic unit bring us a pt that the call started as nothing too unusual; progressive weakness developing over a few days and family called EMS. At the scene during their assessment the pt told them he had a stoma tube for stenosis and grannulosis in the upper airway making intubation almost impossible. Yes, the pt could talk with it. They assumed it was a regular "trach" and did not visualize it under the O2 collar. That is, they didn't visualize until he developed respiratory distress enroute to the hospital. They discovered it did not have the standard 15 mm adapter. It was a 9 mm tube extending from the neck. They thought they could just pull it out and replace it with an ETT. It was a Murphy tube that had internal flanges similar to dry wall hangers. The end results were not good.
I am posting this just to provide some information about the various airways that are in the community. They are a lot more common than one thinks. Many times, healthcare providers don't actually know what they have until they have an incident. "It's a trach" is what I hear in report. The next words I hear is "What the heck is that?" when they finally look closely at the device in the stoma.
Here are some trach/stoma sites with good info about the various airways.
Montgomery tubes for various types of stomas
http://www.bosmed.com/index.html
Overview and very informative
http://www.tracheostomy.com/types.htm
Portex tubes
http://www.smiths-medical.com/catalog/portex-tracheostomy-tubes/
Bivona tubes
http://www.smiths-medical.com/catalog/bivona-tracheostomy-tubes/
http://www.smiths-medical.com/products/tracheostomy/
Many photos of trachs and products including Mallinckrodt/Shiley
http://www.medsupplyco.com/Products/ListProducts.cfm/CategoryID/57/StartRow/1/SortBy/empty
Helpful tips:
1. Never assume "It's just a trach".
2. Visually inspect the airway and device.
3. Assure patency.
4. The patient and caregiver (homecare - not guaranteed in a NH) will usually have good information including make and model.
5. Check or ask for a pre-made emergency kit.
6. Grab the spare if readily available to transport with patient. Many airways are special order for different sizes, shapes and lengths.
7. Grab a couple of appropriate sized suction catheters prior to departure.
8. The 15 mm connector of an ETT will fit into most airways of similar size. For some of the smaller Murphy tubes; you can fit the 15 mm connector over the tube, usually 0.5 mm larger than the Murphy.
9. For BLS, if the pt can talk, you will still have communication with the upper air if you need to bag emergently. There may be some resistance, just watch chest rise and color of patient. Reposition to accommondate the rigid metal or plastic in the neck. Maintain good alignment to keep the tube away from tracheal wall.
10. Laryngectomy with no device, just a stoma; BVM with a pedi/infant mask. You can also inflate the cuff of an ETT and place it on the outside of the stoma for a seal with just the tip inside the stoma.
I am posting this just to provide some information about the various airways that are in the community. They are a lot more common than one thinks. Many times, healthcare providers don't actually know what they have until they have an incident. "It's a trach" is what I hear in report. The next words I hear is "What the heck is that?" when they finally look closely at the device in the stoma.
Here are some trach/stoma sites with good info about the various airways.
Montgomery tubes for various types of stomas
http://www.bosmed.com/index.html
Overview and very informative
http://www.tracheostomy.com/types.htm
Portex tubes
http://www.smiths-medical.com/catalog/portex-tracheostomy-tubes/
Bivona tubes
http://www.smiths-medical.com/catalog/bivona-tracheostomy-tubes/
http://www.smiths-medical.com/products/tracheostomy/
Many photos of trachs and products including Mallinckrodt/Shiley
http://www.medsupplyco.com/Products/ListProducts.cfm/CategoryID/57/StartRow/1/SortBy/empty
Helpful tips:
1. Never assume "It's just a trach".
2. Visually inspect the airway and device.
3. Assure patency.
4. The patient and caregiver (homecare - not guaranteed in a NH) will usually have good information including make and model.
5. Check or ask for a pre-made emergency kit.
6. Grab the spare if readily available to transport with patient. Many airways are special order for different sizes, shapes and lengths.
7. Grab a couple of appropriate sized suction catheters prior to departure.
8. The 15 mm connector of an ETT will fit into most airways of similar size. For some of the smaller Murphy tubes; you can fit the 15 mm connector over the tube, usually 0.5 mm larger than the Murphy.
9. For BLS, if the pt can talk, you will still have communication with the upper air if you need to bag emergently. There may be some resistance, just watch chest rise and color of patient. Reposition to accommondate the rigid metal or plastic in the neck. Maintain good alignment to keep the tube away from tracheal wall.
10. Laryngectomy with no device, just a stoma; BVM with a pedi/infant mask. You can also inflate the cuff of an ETT and place it on the outside of the stoma for a seal with just the tip inside the stoma.
) and was on a ventilator. He could only communicate with blinking.