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Chest intubation indications,precautions and management

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Chest intubation indications,precautions and management

  1. 1. KAMRAN YOUSAF FCPS,MRCS GEN SURGEON,MEEQAT GEN HOSPITAL MADINA MUNAWWARA
  2. 2.  CHEST/INTERCOSTAL INTUBATION OR TUBE THORACOSTOMY IS A LIFE SAVING PROCEDURE WHEREBY A PLASTIC TUBE IS INSERTED INTO THE PLEURAL CAVITY TO DRAIN FLUID,AIR OR BOTH  IT CAN BE PERFORMED AT THE BEDSIDE  EVERY SURGICAL/ER RESIDENT IS EXPECTED TO PERFORM IT AND SHOULD BE TRAINED SO
  3. 3.  TRAUMATIC  AND NON TRAUMATIC  HAEMOTHORAX  PNEUMOTHORAX  PYOTHORAX/EMPYEMA THORAX  CHYLOTHORAX  PST OPERATIVE THORACOTOMY
  4. 4.  LUNG ADHERENT TO THE CHEST WALL  COAGULOPATHY
  5. 5.  CORRECT PROCEDURE,CORRECT PATIENT AND CORRECT SIDE  WRITTEN INFORMED COSENT  PREPARE THE EQUIPMENT  STERILE ENVIRONMENT  DISPLAY THE X-RAYS IN THE ILLUMINATOR BOX  POSITION OF THE PATIENT
  6. 6.  4TH/5TH INTERCOSTAL SPACE  LATERAL BORDER OF PEC MAJ  ANT BORDER OF LAT DOR  HORIZONTAL LINE FROM NIPPLE  APEX JUST BELOW AXILLA
  7. 7.  STERILE GLOVES/GOWN/DRAPES/BETADINE  CHEST TUBE AND THE DRAINAGE SYSTEM  SYRINGE  LOCAL ANAESTHESIA  SCALPEL  ARTERY FORCEPS  THUMB FORCEPS  SCISSORS  NEEDLE HOLDER  SUTURE MATERIALS  GAUZE/DRESSING MATERIALS
  8. 8.  THREE TYPES  THORACOTOMY CHEST TUBE  TROCAR CHEST TUBE  MALECOT CATHETER  SIZE  24-32 F FOR MOST ADULTS  36-40 F FOR HEAVILY BUILT
  9. 9.  OBSERVE PATIET’S  BREATHING PATTERN  OXYGEN SATURATION  VITAL SIGNS  ANXIETY  ANALGESIA BEFORE THE PROCEDURE  READY UNDERWATERSEAL
  10. 10.  MONITOR VITALS,,,30 MIN/2 H,THEN HOURLY FOR 4 HOURS  MONITOR HIS RESPIRATION  RATE,RYTHEM AD PATTERN OF BREATHING  MONITOR OXYGEN SATURATION  POST INTUBATION CXR  MONITOR THE TUBES/DRESSING  PLACEA PILLOW BETWEEN THE PATIENT AND THE TUBE  AVOID COILS OF TUBE,NEVER TO RISE IT ABOVE THE CHEST LEVEL
  11. 11.  IF BLOCKED,ENCOURAGE COUGHING AND MILK THE TUBE  NO UNNECESSARY CLAMPING  EXCEPT DURING TRANSFER/CHANGE  DRAIN OUTPUT RCORD  CHANGE BOTTLE EVERY 24/48 HOURS OR WHEN FULL  ENCOURAGE AMBULATION AND BREATHING EXCERCISES AND POSITIONAL CHANGES  GOOD ANALGESIA AND HYGIENE
  12. 12.  INJURY TO LUNGS  INJURY TO LIVER/SPLEEN  WRONG PLACEMENT  NEUROVASCULAR BUNDLE  INFECTION
  13. 13.  WHEN ITS NO LONGER REQUIRD  THE INDICATION DOES’NT EXIST  FLUID/AIR HAVE BEED DRAINED,LUNG HAS EXPANDED,BREATHING IS NORMAL,SATURATION IS GOOD AND THE CHEST X-RAY IS NORMAL  CLAMP FOR 2 HOURS,NO ISSUES  REMOVE
  14. 14.  DURING THE PROCEDURE  BLEEDING,SATURATION DROP,WRONG INTUBATION  POST PROCEDURE  TUBE DISLODGEMENT,BLOCKAGE ETC
  15. 15.  PRE-OP,,,ENSURE,CONSENT,RIGHT,RIGHT AND RIGHT  ENSURE AEPTIC ENVIRONMENT,EQUIPMENT  ENSURE IV LINE/CXR IN ILUMINATOR  DURING PROCEDURE,MONITORING,READY UNDERWATERSEAL,IV FLUIDS,O2 SUPPLY,SPARE INSTRUMENTS,TUBES  POST PROCEDURE,MONITOR THE DRESSING,TUBES,DRAIN,FLUID LEVEL,BUBBLING,VITALS,O2 SAT,CXR
  16. 16.  LIFE SAVING PROCEDURE  AIR,FLUID,BOTH  ASEPTIC ENVIRONENT,PROPER EQUIPMENT,RIGHT,RIGHT,RIGHT  ANTICIPATE AND PREPARE FOR UNEXPECTED COMPLICATIONS  MONITOR DURING AND AFTER THE PROCEDURE  REMOVE WHEN NOT NEEDED
  17. 17. FOUNDER OF MODERN NURSING

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