Can't Oxygenate, Can't Ventilate, Can't Intubate?

Case 1 EMS was called for a patient who was hypoxic after undergoing a failed tracheostomy tube change at home. The patient, a 62-year-old female, had a Medtronic Shiley tube in place due to severe COPD and obstructive sleep apnea. The tracheostomy tube had been in place for one year. The patient was not on a ventilator, but was tracheostomy dependent. The patient underwent a routine tracheostomy tube change at home by a visiting physician. In this instance, the physician removed the patient's Shiley tube but was unable to replace it with a new device. She became tachypnic and hypoxic after 20 to 30 minutes while attempts were made to change the tracheostomy tube. EMS was called. Upon EMS arrival, the patient was hypoxic to 60% on room air (RA), tachypnic to 40 and tachycardic to 140. She was hypertensive with a blood pressure of 156/96 and agitated. The patient received bag valve mask (BVM) ventilation through the stoma site and, due to the patient's remote location, helicopter EMS (HEMS) was called for definitive airway management prior to transportation given the patient's instability. On aircrew arrival, the patient's oxygen saturation with BVM through the stoma had improved to 95%. She remained agitated and tachypnic. The patient received ketamine and fentanyl for procedural sedation. The patient had a 6-0 tube placed through the stoma via a tube introducer (commonly called a bougie) and was then placed on the transport ventilator. Her oxygen saturation remained in the 9...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Source Type: news