few weeks ago I was called into a pt's room (was a new grad's pt) for desat'ing. noticed right away the peak pressure of 54 cmH20. the pt had a trach and in his circuit you could clearly see the chunks of mucus that he had coughed up. This was a classic clin. sims moment for our new grad. he didn't recognize the airway obstruction based on those two classic signs, I pulled out the inner cannula and showed him the pencil led sized hole he was breathing through. new peak pressure 14 cmH20
This is a classic case of an obstructive problem and that means primarily we are dealing with increased airway resistance. The large disparity between the Pplat and PIP is a give away. Also, the characteristic flow/volume loop findings indicate obstruction as well.
A few things to consider:
1) Really obvious, but often overlooked is a kinked tube
Great video. I can see signs of increased airway resistance on each of those waveforms and loops.
1) On the pressure scalar, the difference between the PIP and Pplat
2) On the flow scalar, there is prolonged e-time
3) On the volume scalar, Its taking longer for the exhaled volume to return to baseline
4) On the PV loop, there is a significant exp "bulge"
5) And on the FV loop, the is the prolonged e-time and "scooping" as you pointed out.
Thanks again for posting this.
atomicdog2020 3 weeks ago
few weeks ago I was called into a pt's room (was a new grad's pt) for desat'ing. noticed right away the peak pressure of 54 cmH20. the pt had a trach and in his circuit you could clearly see the chunks of mucus that he had coughed up. This was a classic clin. sims moment for our new grad. he didn't recognize the airway obstruction based on those two classic signs, I pulled out the inner cannula and showed him the pencil led sized hole he was breathing through. new peak pressure 14 cmH20
mazdaguy42 1 month ago
This is a classic case of an obstructive problem and that means primarily we are dealing with increased airway resistance. The large disparity between the Pplat and PIP is a give away. Also, the characteristic flow/volume loop findings indicate obstruction as well.
A few things to consider:
1) Really obvious, but often overlooked is a kinked tube
2) Bronchospasm (asthma history with this kiddo)
3) Mucous plug or some type of obstruction
TheAncientScholar 1 year ago