By Florian Falter
This instruction manual is a advisor to top perform in interventions normally encountered within the ICU. it really is clinically oriented supplying :step-by-step reasons and illustrations of so much invasive techniques, fee lists to ensure the indication is true, fee lists to make sure acceptable evaluation as soon as the process has been performed. the data is definitely obtainable supplying sensible recommendation and crucial history for each member of the multi-disciplinary group taking good care of seriously unwell sufferers. it's going to serve the senior advisor who has no longer played a process for your time in addition to the junior surgeon short of an aide memoire.
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Additional info for Bedside Procedures in the ICU
Bronchoscopy 33 Therapeutic Interventions • Bronchial toilet and removal of obstruction – atelectasis is a common problem in mechanically ventilated patients. This frequently causes collapse and consolidation with subsequently impaired gas exchange. Relieving any obstruction not only improves radiological appearance (see Fig. 3) but also can markedly improve respiratory function and the overall clinical picture. • Hemoptysis – massive hemoptysis is defined as the coughing up of >400 mL of blood in 24 h or >200 mL in any single event.
Overall FOB is a safe procedure, which is generally well tolerated with very few major complications. • Patients who are not already ventilated are at risk of deteriorating respiratory function during the procedure. Some patients might even require intubation and mechanical ventilation • The risk of worsening hypoxemia and subsequent arrhythmia is associated with sedation • Throat discomfort • Vocal cord injury • Epistaxis, if the procedure is performed via the nose in awake patients • Patients requiring airway intervention have the additional risk of − Bleeding (1–5%) − Pneumothorax (5–10%) Preparation The safe conduct of a bronchoscopy in critically ill patients requires careful preparation and attention to detail.
2 Jaw thrust Techniques • Jaw thrust: Two fingers are placed behind the angle of the jaw on each side, and the is jaw gently lifted straight upwards (see Fig. 2). • Chin lift: The chin is gently lifted and the head tilted back (see Fig. 3). Care must be taken in patients with potential cervical spine injury or arthritis. • Oropharyngeal airway: The airway is inserted into the mouth with the tip facing the palate. After advancing a few centimeters, the airway is rotated through 180° before advancing further (see Fig.
Bedside Procedures in the ICU by Florian Falter