[Dancin'Mom]

I recently had a trach patient who was on the blender receiving up to 90% oxygen, with sats in mid 80's, had pneumonia, COPD and many other diagnoses.( I understand the whole oxygen issue with COPD patients.) We were suctioning her as needed and still she was having a hard time breathing, very anxious too. (I probably would be too if I couldn't get my breath.) Of course I had called the doc on call and he had assessed her (she eventually moved to the ICU from telemetry/step-down unit), ordered blood gas and chest xray that revealed total white-out in her lungs from pneumonia. We had bagged her (with help of more experienced nurses on floor), but evidently the cuff was deflated and the RT got really mad about this. Why exactly does the cuff need to be inflated with bagging? I don't really understand totally, so patient doesn't aspirate, what else? The patient transferred to ICU and put on vent. Anyway, respiratory issues are scary and I plan on following a RT to learn more. Thanks for any input.

[janfrn]

When the cuff is down and you're bagging a patient, most of the air/oxygen you're attempting to push into their lungs will take the path of least resistance... around the trach tube. So really, bagging them that way isn't going to do much good. Another potential is inflating the stomach, which will be really unpleasant when whatever is down there isn't down there any more. To say nothing of the lack of room for the lungs to expand when the stomach is full of air and pushing the diaphragm up.

Respiratory crises can be very frightening to everyone in the room. I think you're making a good decision to spend some time with the RT. They have a lot to share about managing airways, effective ventilation and oxygenation and how to do it all without panicking.

[PiPhi2004]

Originally Posted by janfrn

When the cuff is down and you're bagging a patient, most of the air/oxygen you're attempting to push into their lungs will take the path of least resistance... around the trach tube. So really, bagging them that way isn't going to do much good. Another potential is inflating the stomach, which will be really unpleasant when whatever is down there isn't down there any more. To say nothing of the lack of room for the lungs to expand when the stomach is full of air and pushing the diaphragm up.

Respiratory crises can be very frightening to everyone in the room. I think you're making a good decision to spend some time with the RT. They have a lot to share about managing airways, effective ventilation and oxygenation and how to do it all without panicking.

Yep, what he said. We had to spend a day with RT when we started on the unit, very helpful to understand whats going respiratory wise (we get a lot of lung stuff) I would DEFINATELY recommend spending some time with RT!