tniuqs Posted January 19, 2012 Share Posted January 19, 2012 (edited) Bada Boom Bada Bing ... its the the innominate artery and comes right off the aorta, I sure hope that ninja is a cardiac surgeon as the fix is crack the chest, honestly never thought of transensemic acid ? <insert head scratching smiley> Realistically pre-hospitally a real rarity i would hope of erosion, more so in chronic ventilated fragile patients. I would think more so from a rupture from of a congenital malformation in the field. But it does put a sober thought when slamming a "prescribed volume" of air in a cuff, doesn't it ? The mortality morbidity of innominate rupture is about 99.99 % even if your in an ICU and close to an OR. Permission to tell a war story ? I have had one Inferior thyroid artery erode, I pretended to play the little Dutch boy and plug it with my finger, it was a big stoma, the blood squirting on the curtains was a dead give away. The intensivist had me plug the hole for about 2 hours "talk about cramped fingers !" and of course in the middle of the night the unwritten rule I do believe. Cautery solved that problem Surgeons quote: "the scorched earth policy" the patient had 2 units packed cells and synthyroid after that bloodbath. Far more of a risk with real tracheostomy long term in situ as if you ALL haven't had occasion to transport a pt with a trach and watch the trach tube pulsate with every heartbeat, puts a different spin on things as the term ass puckering comes to mind for me now. (ii) Prehospitally? With a TEF, deflate the balloon, advance the ET tube to below the fistula, reinflate, cross fingers. ME TOO LOL. With a fistula involving major vascular structures... I think you would have to consider how rapid the hemorrhage is occuring and how much it's interfering with ventilation and oxygenation. Unless they're getting really hypoxic / incredibly hypercapnic, I think it might be best to do nothing. Deflating the cuff risks removing a potentially tamponading effect, and inflating it to increase the tamponade risks further eroding the vessel and turning a sentinel bleed into an end-of-life event. If you're getting bright red blood up the tube, it's probably too late, but we could try placing the tube more distally (with some thought to the fact that it may be the tip that's eroded. In either case, it's possible we're losing large amounts of blood into the mediastinium. Transexanamic acid? Interesting thoughts, I like the way you think although diagnosing this in the field may be a bit of a challenge, if I had a lot of frank bright red blood up a ETT .... I think??? I might try doing a Right Mainstem or Left Mainstem (harder) and isolate a lung as cracking a chest is not quite in my scope of practice . Sorry Mobster for going off topic .. cheers Post intubation Et Tube = 1-2? (I dunno..... not much.... ) BVM with no diverter = 0.5-1 ? (again... dunno really) Mobsters Homework LOL. See exercise #2 <edit> page 148 http://books.google....ressure&f=false Edited January 19, 2012 by tniuqs Link to comment Share on other sites More sharing options...
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