Stomas Ostomies and Home Ventilators By Wesley Rolfson.
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Transcript of Stomas Ostomies and Home Ventilators By Wesley Rolfson.
Stomas Ostomies and
Home Ventilators
By Wesley Rolfson
Tracheostomies
• “Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea”1– Often performed for long term ventilation– Inner and outer cannulas– Some have cuffs
• Endotrachial tubes cause damage to:– Vocal cords– Trachial tissue
1. Jonathan P Lindman, MD Tracheostomy, eMedicine, http://www.emedicine.com/ent/TOPIC356.HTM, 2006
Tracheostomies
• Common Indications– Obstructions– Facial or Neck trauma– Subcutaneous emphysema – Edema – Long Term mechanical ventilation– Chronic Aspiration issues– Preparation for extensive facial or neck surgery– Sleep apnea not treatable by a less invasive
procedure
Tracheostomies
• They are prone to respiratory infections
• Stenosis of tissue around trach tube
• Erosion of trachea into the esophagus
• Granuloma– Growth of inflammatory tissue in or around the
trachea
Tracheostomies and EMS
– Caregiver or patient is calling because
• Cannula is displaced• Something is obstructing the
cannula• Issues with a ventilator• Respiratory infection/ congestion• Bleeding
– Recent tracheostomies are high risk patients
• Stoma• Education issues
Treating their Trach.
• History– Last time changed– Recent illness– Prior trach issues– Native airway?– Past Medical history
• Breathing– Position Patient– Cough– Suction– Ventilate patient
Treating their Trach.
Cannula/Obstruction– Cough– Suction– Remove cannula– Entubation
• Remember– Native airway may still
function– You can disconnect
the ventilator as long as you can breath for them
Entubating a Stoma
• ****Check with local ****Check with local protocols****protocols****
• Deflate the cuff • Remove the cannula• Place ET tube 1-2 cm through
stoma• Inflate cuff until no air is
escaping– Do not over inflate
• Check for placement using standard methods
• Secure tube using tape
Home Ventilators
• Used for patients – Post surgery– Sleep apnea– Neuromuscular conditions
• Quadroplegia, muscle weakness, Polio
– Parenchymal lung diseases• COPD, pneumonia, fibrosis, rheumatoid arthritis,
Lupus, sarcoidosis
Types of Ventilators
Ventilators
• Common issues– Mechanical failure– Improper use or training– Change in patient condition– Tubing disconnected or obstructed
Ventilators and EMS
• ****Follow local Protocols********Follow local Protocols****
• Repostion patient
• Suction airway
• Reconnect tubing
• Take over breathing for patient if needed
• Get a good history and record information about ventilator (flow and rate)
Ostomies
• Any Surgery that produces a stoma, specifically surgeries that divert the Intestines, Colon or Ureters. – Colonostomy, Ileostomy, Urostomy
• Common reasons for Ostomies– Cancer, Diverticulitis, Crohn’s Disease,
trauma, neurological diseases, genetic defects
Ostomies
Ostomies
• Should have an ostomy bag in place
• Depending on location of ostomy may produce liquid or solid fecal matter
• Digestive enzymes may corrode skin around stoma
• Ostomy site should be pink or red
• Most pouches can be emptied without removal
Ostomies and EMS
• Common complaints are Cramps, constipation, pain, diarrhea, bleeding, tearing, excess gas
• Check for skin and systemic infections• Assist in emptying ostomy bag as needed• Apply a sterile dressing if no ostomy bag found• Avoid puncturing ostomy bag
– Contents should be considered caustic
Bibliography• A K Simmonds Risk management of the home ventilator dependent patient, Thorax, 2006; 61
369-371• Cynthia Bissell, Aaron’s Tracheostomy Page, Tracheostomy Complications
http://www.tracheostomy.com/care/complications/index.htm updated 05/14/07• Gary D. Vogin, MD Living with a Colostomy, The Cleveland Clinic 2001• Jan Clark, RNET, CWOCN, Peg Grover, RNET, COLOSTOMY GUIDE, 2004• Jonathan P Lindman, MD Tracheostomy, eMedicine,
http://www.emedicine.com/ent/TOPIC356.HTM, 2006• John Nozum, Sleep Apnea: Frequently Asked Questions, http://
home.att.net/~jnozum/Trach/FAQ.htm , 2006• John Prestwich 'I lived in an iron lung for seven years' Technology, November 14th 2005• Richard Robinson, Breathe Easy Options Offered for Respiratory Care ,QUEST, MDA
Publications, October 1998, Vol 5 no. 5• Robert S. Porter, M.A., Bryan Bledsoe, D.O., Richard Cherry, M.S. Paramedic Care Principles
and Practice Special Considerations Operations, second edition, Brady, Prentice Hall Health, Upper Saddle River, NJ, 2006 p 1:597-600 5:130-131, 5:271-276
• Sharon Doty, Tanya White, Victor Segura Frequency, Causes, and Outcome of Home Ventilator Failure, Chest 1998; 114; 1363-1367
• UW Department of Surgery, Ostomy Care Service http://depts.washington.edu/ostomy/colo-ileo.html, © 2004.