Resp Care
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Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. Of the many purported advantages of tracheostomy, only patient comfort, early movement from the ICU, and shorter ICU and hospital stay have significant supporting data. Even the belief of increased safety with tracheostomy may not be correct. ⋯ Mortality is not worse with tracheotomy and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of when to perform a tracheostomy continues to be individualized, should include daily weaning assessment, and can generally be made within 7 days of intubation. Bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity.
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Case Reports
Mediastinal teratoma with pulmonary involvement presenting as massive hemoptysis in 2 patients.
Massive hemoptysis is described in many disease processes. However, a mediastinal teratoma is rarely considered in a patient presenting with massive hemoptysis. ⋯ Flexible bronchoscopy can be diagnostic in cases of a mediastinal teratoma with involvement of the bronchial tree. We report 2 cases of hemoptysis caused by mediastinal teratoma with bronchial communication.
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The development of less expensive, smaller, and more reliable video cameras has revolutionized the design of laryngoscopes and the process of endotracheal intubation. The term video laryngoscopy defines a broad range of devices, distinct from fiberoptic bronchoscopes, in which a video camera is used in place of line-of-sight visualization to accomplish endotracheal intubation. ⋯ Each model of video laryngoscope has its own unique strengths, weaknesses, and best applications. For the purposes of this review, video laryngoscopes are grouped into 3 different designs: stylets, guide channels, and video modifications of the traditional (usually Macintosh) laryngoscope blades.
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Emergency airway management is associated with a high complication rate. Evaluating the patient prior to airway management is important to identify patients with increased risk of failed airways. Pre-oxygenation of critically ill patients is less effective in comparison to less sick patients. ⋯ Supervision of emergency airway management by attending physicians significantly decreases complications. Standardized algorithms may increase the success of emergency intubation. Attention should be paid to cardiopulmonary stability in the immediate post-intubation period.