A non-invasive alternative, if available to you, in a situation like this=
is the use of Heliox. Good for two reasons: Probably helpful with =
reactive airway disease and secondly it has been used sucessfully in
cases of upper airway obstruction. Might or might not have forsatlled
the need for invasive airway management.
The etiology of the PNX is not secondary to 'granulation tissue'. After a=
it occured AFTER an open airway had been secured via tracheostomy. Rathe=
it resulted because someone inappropriately hyperventilated this patient
after the airway was established in an attempt to rapidly correct the pH.=
This is a common and sometimes fatal error. Modern management of an
asthmatic calls for controlled HYPOventilation. The pCO2 should be ignor=
provided that oxygenation is adaquate. If the pH is so low as to cause
hypotension or other complications then it can be corrected with HCO3.
This is standard fare.
I agree that needle cric would probably have been inadaqute in this case =
problem is one of VENTILATION and not OXYGENATION. It would also tend
the problem of barotrauma which occured anyway but for a different reason=
as noted =
However, I do not, a priori, see any contraindication to surgical cric an=
after trying Heliox would probably have been the procedure of choice had
not been available. I suppose it is possible that the granulation or scar=
would prevented a sucessful insertion of the tube from above the trach
without ENT assistance it would have been the only option available.
By the way, I beleive that the manner in which this list suppresses
opinons is extremely ignorant, undemocratic and regressive.
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: