🤒Warna KAHAK Tunjuk Tahap Kesihatan PARU-PARU Anda!

Salam @akufisio, video kali ini saya menerangkan 1) Betul ke ada warna kahak yang sihat dan warna kahak yang tak sihat? 2) Apa perlu buat jika warna kahak tak normal? 3) Kahak ni normal ke untuk orang yang sihat? ADA PERSOALAN NAK TANYA? Comment persoalan anda dibawah, InsyaAllah saya akan bantu jawab ketika berkelapangan. Senior Physiotherapy: Muhamad Shahril Bin Senan @akufisio Video Sponsored by: https://erobarn.com/ Fb & Ig: @akufisioofficial Blog: https://akufisio.blogspot.com/ Background Music by: https://www.bensound.com/

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Punca Peparu Bocor (Pneumothorax)

Paru Paru Bocor dan Kesan pada tubuh manusia.

Bismillahirahmanirahim , 3 Minggu lepas seluruh negara menangisi pemergian Wira kita iaitu Allahyarham Adib , Anggota Bomba yang terlibat di dalam rusuhan kuil seafield tempoh hari , semoga Allah Merahmati beliau sebagai seorang Syahid  (Al Fatihah). Kita semua dimaklumkan antara kecederaan yang dialami oleh arwah ialah tulang paru paru patah dan kebocoran paru paru .
Dalam blog saya , ingin saya kongsikan info apa itu yang dikatakan paru paru bocor , dan kesan terhadap tubuh badan manusia.

Kebocoran peparu adalah keadaan yang amat berbahaya. Sekiranya anda mengalami sakit dada atau bahu yang melampau disertai, sesak nafas, degupan jantung yang cepat, dan kulit berwarna bertukar kebiru dan kehitaman kerana kekurangan oksigen, anda mungkin mengalami kebocoran paru-paru tanpa anda sedari.
Dalam istilah dunia perubatan ,maslah  paru-paru bocor ini dikenali dengan istilah pneumothorax. apabila ini terjadi, Anda tetap boleh bernapas, akan tetapi paru-paru  anda tidak dapat mengembang secara normal, sehingga oksigen yang cuba diserap  akan berkurang serta mengakibatkan anda mengalami komplikasi pernafasan yang teruk.

Faktor terjadinya Peparu Bocor?
Secara umumnya ,Setiap orang mempunyai sepasang paru-paru, yang berfungsi untuk menerima serta menyerap oksigen untuk disalurkan ke sel darah merah dalam aliran darah. Tambahan pula, sel darah merah membawa oksigen ke seluruh badan, untuk digunakan dalam sel-sel badan bagi kelansungan kehidupan manusia. Bagi kami yang terlibat di dalam bidang perubatan , masalah kebocoran paru tidak boleh dianggap remeh dan mudah.Ini kerana keadaan ini, udara yang memasuki ruang antara paru-paru dan dinding dada boleh mengakibatkan Udara ini menekan dan memampatkan paru-paru dari luar, dengan itu ia  menghalang paru-paru untuk berkembang semasa bernafas. Kebiasaannya kebocoran hanya berlaku dalam satu bahagian paru-paru kecuali ianya boleh berlaku multiple atau banyak tempat jika terjadinya trauma atau kemalangan.

Punca Paru paru Bocor  boleh terjadi .

1. Kecederaan pada bahagian dada,kecederaan akibat luka tembak atau luka dan luka yang tumpul, patah tulang rusuk, dan kemalangan kereta dimana stereng kereta menghentak kedada, Pukulan objek tumpul secara kuat di dada antara penyumbang masalah terjadinya peparu bocor ini.
2. Terdapat penyakit paru-paru yang menyebabkan tisu paru-paru menjadi rosak dan bocor. Sebagai contoh, penyakit pulmonari obstruktif kronik (COPD) dan radang paru-paru,Pesakit Tibi dan Kanser Paru Paru.
3. Kebocoran Paru-paru yang teruk boleh berlaku pada orang yang sihat. Sebagai contoh,Tekanan udara yang penuh dengan bentuk udara di luar paru-paru anda, kemudian pecah, menyebabkan tekanan secara tiba tiba seperti batuk yang terlalu kuat , Keadaan ini adalah paling biasa pada lelaki berusia di bawah 40 tahun dan selalunya mereka ini ialah Perokok Tegar.
4. Pesakit yang Bernafas menggunakan mesin atau alat pernafasan, seperti ventilator dalam satu jangka masa yang lama.(Komplikasi)
5. Pesakit yang Telah menjalani pembedahan pada dada atau perut.(Komplikasi)
6. Pesakit yang mengalami saluran pernafasan yang tersumbat ,atau lemas di dalam air serta asap.

Paru paru yang bocor  adalah keadaan yang serius yang boleh mengancam nyawa jika tidak dirawat dengan serta-merta. Jika kebocoran hanya terjadi di bahagian kecil paru-paru, maka anda mungkin tidak mengalami gejala. Tetapi jika paru-paru yang bocor dalam kebanyakan  bahagian paru-paru anda, anda mungkin merasakan sesak nafas dan degupan jantung yang cepat tanpa dapat dikawal dan akan menyebabkan anda tercungap cungap. Kesan daripada Paru paru yang bocor boleh mengganggu proses penghapusan karbon dioksida yang biasanya akan dikeluarkan semasa kita menghembus nafas. Sekiranya tidak dikeluarkan, karbon dioksida boleh menyebabkan pH dalam darah dan cecair badan lain berkurang, dan boleh menyebabkan anda mengalami keracunan pernafasan yang dipanggil Metabolic Acidosis.

Apakah langkah pencegahan serta tindakan yang perlu anda tahu 

Pengendalian serta perawatan masalah paru paru bocor adalah untuk mengurangkan tekanan udara di rongga paru-paru dan untuk mengekalkan tekanan udara yang biasa di dalam paru-paru, Bagi menyokong proses pernafasan yang optimum. Jika perlu, doktor akan memasukkan jarum atau paip ke rongga paru-paru untuk mengeluarkan udara yang berlebihan.Dalam prosedur ini , pesakit perlu mendapatkan pemerhatian di hospital untuk mengelakkan komplikasi paru-paru akan bocor semula.

Dalam dunia perubatan ,Sebenarnya, tidak ada cara untuk mencegah paru-paru daripada bocor. Seseorang yang telah mengalami kebocoran paru-paru, dapat mengalaminya lagi jika mempunyai masalah serta risiko seperti yang saya nyatakan diatas. Tetapi terdapat beberapa perkara yang boleh dilakukan untuk mengurangkan risiko bocor paru-paru yang berulang.

Berikut adalah beberapa perkara yang perlu anda perhatikan, termasuk:

• Jika anda seorang yang aktif merokok, anda boleh mula berhenti dari sekarang. Tanya doktor anda untuk mendapatkan bantuan sekiranya anda mengalami kesukaran untuk berhenti , ini kerana rokok antara penyebab punca kebocoran paru paru ini

• Jika anda mempunyai penyakit paru-paru tertentu, berunding dengan doktor anda dengan kerap.
• Elakkan aktiviti berisiko yang boleh menyebabkan perubahan tekanan dalam paru-paru, seperti menyelam atau selam skuba.
• Jika anda mengalami hentakan didada yang kuat dan diikuti dengan kesukaran bernafas pastikan anda mendapatkan rawatan dengan segera

Oleh itu Jika anda mengalami beberapa gejala yang berkaitan dengan paru-paru yang bocor, anda dinasihatkan untuk mendapatkan rawatan perubatan dengan segera, kerana rawatan yang cepat dapat memulihkan anda. Jika keadaan paru bocor anda teruk, rawatan lewat boleh menyebabkan komplikasi yang membawa maut . Wallahuaklam.

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The Weakest Heart

The Types of Weakest Heart 

Bismillahirahmanirahim,In the early stages, weak cardiac characteristics may have no symptoms. But once the condition gets worse, then various conditions can arise. Therefore recognize the weak heart symptoms from the beginning so that you can anticipate it. The absence of severe symptoms of weak cardiac arrest, make the sufferer still alive and normal. It is these that often deceive many, they do not realize that the heart is weakening from time to time.
       However, whenever you experience weak cardiac characteristics, you should immediately consult your doctor. This is because in some cases, weak cardiac symptoms can deteriorate rapidly so as to threaten safety. One of the major causes of heart failure is cardiomyopathy. In most cases, this disease will make the heart muscle in a weak condition so unable to pump blood to the whole body as it should. Based on the cause, whether coronary heart disease or drug side effects, there are actually various types of cardiomyopathy. But they all can lead a person to experience weak cardiac characteristics.

Here are the features of the weak heart that you should be aware of:

Short Breath 
Whether it's time or activity while relaxing, weak heart patients generally have a short breath. Not only that, some sufferers often find themselves breathless, especially if the activity is too heavy. This condition is caused by weak heart contraction making the blood less pumped well so that eventually a lot of blood that is crowded with lungs.

Often cough
 If you often have a long-standing cough, which does not heal, or often recurrence, it is not a common cough disease. It may be one of the weak heart characteristics. The cause is the presence of fluid in the lungs which can be a mixture of blood and sputum. Therefore, those with heart disease often have blood cough.

Easy to forget 
Not only elderly people who often forget, young people can. One of the causes is the lack of oxygen intake (which is carried blood) to the brain so memory is decreasing.

The heart sounds like a whisper (heart murmur)
 Not only pounding, weak heart patients may find that her heart produces some kind of noise. This sound can be clarified its existence with the help of a stethoscope.

Chest pain 
Something overloaded Feeling And especially after the activity or eating heavily, if you often feel pressure on the chest, it is also one of the most common weakest heart characteristics. Beware also because it can be a sign of the Coronary Heart Disease

High blood pressure or low 
It is no secret that heart disease is often associated with high blood pressure. And these two diseases are synonymous with high levels of salt in the body. As mentioned above, heart failure in working ideally ultimately forces the kidney to store more salt in the body so that blood pressure goes up. However, one of the weak heart characteristics is also characterized by low blood pressure. This is because the weak heart pump function will have a weak pressure as well.

Lack of appetite decreases 
The average heart rate sufferer has no appetite and ideal weight. This is because of the healthy blood intake that should reach the digestive organs a bit, so often a sense of satiety although the sufferer may not eat at all. Also due to disturbance of liver function.


Often headaches
 The lack of oxygen intake to the brain can also make headaches. While the amount of certain substances (such as sodium for example) in the blood is uncontrollable, it can cause less focus. No wonder some people do not realize that he's suffering from a weak heart.

Heart palpitations 
Do not complain If the heart is often pounding (arrhythmia) or too fast (palpitations), when there is no idol in the surroundings, then this is also a sign that you have a weak heart. This is because the heart is trying to mask its weakness by speeding up its performance in distributing blood throughout the body

Easily tired, sweaty, and unconscious 
This symptom is not only caused by a weak heart, as many other conditions can cause it. When the heart fails to contract as it should, oxygen carried by the blood will not spread properly to the tissues and organs of the body. This causes the function of the organs and tissues of the body to decrease so that it makes one easy to tired. Therefore, it is no wonder that weak cardiac sufferers are also easily sweating and unconscious.

Foot swelling Legs and hands look swollen
The trigger may be due to disturbance of blood flow to the kidneys so it forces the organ to produce more hormones. Consequently, salt and water buildup occurs. Swollen feet can also occur as blood flow to the heart becomes obstructed, because the weak heart makes the blood queue to get there.

Swelling Vein in the neck
The next characteristic weak heart is increased jugularis vein pressure (JVP). The venous vein is located on the neck, left and right sides of the front. Increased JVP (jugular vein pressure) occurs due to blood flow from the head area to the heart is blocked so much blood is stacked (blocked). From the outside it will grow bigger.

Finger clubbing 
When cyanosis lasts long, then the growth of fingers and nails will be affected. Finger tabs mean that the fingertip has a larger size such as a drum stick, with a nail so curly.

Cyanosis 
The term medical cyanosis means bluish, bluish is caused by the amount of carbon dioxide over oxygen in the blood. Patients with weak heart will certainly experience this because blood flow is not smooth so that the exchange of oxygen and carbon dioxide becomes not as fast as normal people. Blueness can be seen on the lips, palms, nails, and mouth.

The liver Megally
 The explanation is similar to the weak cardiac character in point 8 above, due to blood flow to the heart inhibited, there is a dam in the liver. Thus the liver becomes swollen and enlarged, of course it will cause symptoms of discomfort in the stomach and also decreased appetite.

Large abdomen 
The dehydration of the fluid, whether in the abdomen or lungs, can make the body of the weak heart patients appear bloated or large. This happens because the heart failure condition will cause disturbance as well as liver function. When the liver function is also disturbed, the buildup of the fluid is not only on the feet, but also on the stomach called ascites.

Nausea 
Nausea is the sensation of an urge to vomit. Nausea can be acute and short-lived, or it can be prolonged. When prolonged, it is a debilitating symptom of the Heart weakness, Nausea symptoms are frequently difficult for people to describe. Nausea symptoms are not painful but very uncomfortable feelings that are felt in the chest, upper abdomen, or back of the throat. Nausea can also be associated with the sign of heart problem.

If you are experiencing one or more of the above, then check with the nearest hospital and get a consultation with the Dr. Its better to prevent rather than make it worse .Wallahuaklam

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Guide line for suctioning technique

Guidelines for Suctioning

Objective

Bismillahirahmanirahim

• To maintain a patent airway by removing mucous secretions and all foreign materials from the oropharynx (mouth and throat) and/or nasopharynx (nose).
• Promote his or her oxygenation and ventilation.
• When there is a presence of a respiratory tract infection or a lung-related disorder, the lungs produce a thick substance known as sputum. This sputum can make it hard to breathe, cause coughing, and harbor bacteria.
• The accumulation of sputum can sometimes be an indication for a doctor to ask for a sputum culture.

Sputum Culture and Sensitivity 

(Sputum C & S)

Alternate Names: Culture and Gram Stain

• This fast, relatively painless test helps laboratory technicians study the bacteria or fungi that might be growing in the lungs and causing the production of the sputum. This can help them find the cause of the illness.
• The most difficult part of a sputum culture is often getting enough material in a sputum sample for testing
• Once the sputum sample is taken for analyzing, it will be then taken to the laboratory to be placed on a special plate that has a nutrient that helps bacteria or other pathogens present in the sputum to grow.
• The laboratory will run a number of tests to determine if the growth is a bacterium, a virus, or a fungus. The laboratory will work to tell the difference between bacteria that makes a person sick and those that helps keep a person well.
• Over the next few days, different antibiotics are added to determine the most effective antibiotic or antifungal to treat the infection.
• A Sputum C & S is also used to diagnose tuberculosis, and determine the most effective treatment for the patient

Getting the specimens 

through suction &Types of Suctioning

• Open Suction

patient disconnected from ventilation device and suctioned with regular suction catheter.

• Closed Suction

utilizes an in-line suction catheter with patient remaining attached to mechanical ventilation. This technique is recommended all for patients, especially those with high oxygen requirements or increased levels of Positive Expiratory End Pressure (PEEP).

NASOPHARYNGEAL  AND
OROPHARYNGEAL
SUCTIONING

• PPE
• Face mask
• Gloves
• Sterile gloves
• Apron E

Apparatus

• Tubing drainage
• Suction catheter
• Saline solution
• Mucus extractor
• Gauze
• Suction Vacuum

Appropriate sized catheter

• Neonates 5 – 8 Fr.
• Pediatrics 8 – 12 Fr.
• Adolescents 12 – 14 Fr.

What to start ?

1. ·         Perform hand hygiene and don PPE.
2. ·         Set up sterile saline for instillation and for flushing of catheter between catheter passes.
3. ·         Open suction catheter package maintaining the sterility of catheter.
4. ·         Attach catheter end to connection tubing from the suction apparatus.  Adjust wall  suction. 
5. ·         Recommended pressures should not exceed 80 – 120 mmHg for pediatrics and 80 -100 mmHg for neonates. Cleanse hands and put on sterile gloves.

Method

1. With sterile gloved hand, advance catheter to pre-measured depth without applying suction.  Utilizing measured depth ensures suction catheter does not extend beyond the pharynx and cause trauma.
2. Apply intermittent suction while slowly withdrawing the catheter, rotating catheter between the finger and thumb.  Continuous suction may be warranted with thick, copious secretions.
3. Duration of intermittent suction should not exceed 10 seconds in paediatric patients or 5 seconds in neonate. 
4. Duration of continuous suction should not exceed 5 seconds in neonate or paediatric patient2.

Wallahuaklam.

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Sneeze Effect in human body

Why Do We Sneeze? 

Bismillahirahmanirahim ,Everyone must have experienced sneezing. Whether it's relaxing or being focused on something, suspected or not, sneezing can just happen. So, how can sneezing happen? What are the triggers? Let's look at the full explanation of the mechanisms of sneezing and the many interesting facts that cover it the following.

Mechanism of the occurrence of Sneezing Sneezing is the body's natural mechanism in clearing the nose from the entry of foreign particles. When foreign particles such as dust, dirt, pollen or other irritants enter the nose, the foreign particles will interact with the fine hair and mucous membranes that envelop the nasal cavity.

At that moment, sneezing stimulation will arise. The receptor in the nasal lining sends the impulse through the fifth cranial nerve to the sneezing center of the medulla oblongata as a signal that something must be removed from the respiratory tract. The body immediately prepare for a contraction. The esophagus and the eyes are forced to close, the tongue moves to the roof of the mouth and the chest muscles as well as the diaphragm in the stomach will strengthen. Eventually the air, saliva and mucus will come out of the nose as well as the mouth, and there will be a natural reflex that we call sneezing. Sneezing is also a form of body defense activity against bacteria or viral diseases that attack. That is why when a person is exposed to the flu for example, he will automatically sneeze several times to remove bacteria or viruses from the respiratory tract. In addition, environmental factors such as changes in temperature, pollution, drugs and certain cosmetic products can also trigger sneezing. Although the mechanism of sneezing is generally the same in every person, but the way everyone sneezes can vary.

Why Do We Close Our Eyes When Sneezing?
The nerves present in the nose and eye are related. The closing of the eyes when sneezing aims to protect the tear ducts and blood capillaries so as not to be contaminated by foreign particles, bacteria or viruses coming out of the nasal membrane. That is the reason behind closing our eyes when sneezing.

Is Sneezing Can Be a Serious Problem? 
Basically, sneezing is a natural reflex of the body is very normal and not to worry about. However, in certain conditions, such as nosebleeds or migraines, the frequency of sneezing will be at risk of aggravating both conditions. In addition, sneezing occurring chronically or repeatedly over a long period of time, can be a sign of an underlying health disorder. For example, such as allergic rhinitis, if not controlled properly, it can trigger other infections such as sinusitis, nasal polyp or ear infections. Therefore, it is better to immediately see a doctor if sneezing is experienced too often or chronic to prevent serious problems that could arise. It is important to never withhold sneezing under any circumstances. Why? because these actions can cause adverse health effects. Pinching your nose or closing your mouth to block sneezing can interfere with blood flow to the brain. Causes blood vessels and nervous tissue to be depressed so that it can cause headaches, damage to the eardrum to the destruction of blood vessels. Bad habits of sneezing will also force the bacteria back into the nasal cavity and ear canal, so it is not likely to trigger the occurrence of infection.

Amazing Facts About Sneezing 
There are some interesting facts about sneezing to know, including:

• Sneezing speed can reach 160 kilometers per hour. 
• Most people do not realize that when a sneeze the heartbeat will slow down naturally. 
• In a sneeze there are at least 40,000 water grains containing hundreds of thousands of germs. 
• When sleeping we will not be able to experience sneezing because the muscles of the eyes and nose are paralyzed by the brain.
•  In some people, sneezing can be triggered by orgasm and sunlight.
•  No matter when it is, sneezing can just happen because it is a natural body mechanism that should be grateful.
•  Remember, never hold it because it can be bad for health.

Even so, keep in mind attitude or norm when sneezing. Try to cover the nose and mouth with a tissue to prevent the spread of germs and diseases. If it's not fast enough to reach for a tissue, sneeze with your upper arm instead of by hand. Wallahuaklam.

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Active cycle breathing technique method

ACBT (ACTIVE CYCLE BREATHING TECHNIQUE)

Bismillahirahmanirahim ,

A simple sharing regarding a method of breathing technique.

What is ACBT?

The ACBT is a technique to help you clear secretions from your chest. Coughing alone can be tiring and ineffective. The ACBT uses different types of breaths to make it easier to clear secretions by shifting them form the outer part of your lungs towards the main airways.

What do I do?

 The ACBT can be used in any position that you are comfortable in. Many people find upright sitting the best, but side lying positions can help with clearing secretions.

Relaxed Breathing / Breathing Control

This is normal, gentle breathing using the lower chest.

1. Rest one hand on your abdomen so that you can feel it rise and fall with your breathing.

 2. Breathe in gently feeling your hand rise and your lower chest expand.

 3. Breathe out gently allowing your shoulders to relax down. The breath out should be slow, like a “sigh”

Deep Breathing 

1. Breathe in deeply feeling your lower chest expand as far as possible. Try to keep your neck and shoulders relaxed. 

2. Hold the breath for up to three seconds. 

3. Let the air out gently. 

Huff 

This is a short sharp breath out through an open mouth that helps to force the secretions out. 

There are two types of huff:

1. From a medium sized breath in, with a long “squeezy” breath out.

2. From a big breath in, with a shorter sharper breath out.

3. Start with the first type and progress to the second, using breathing control to recover between huffs. Remember the huff needs to be through an open mouth, using your abdominal muscles.

Cough 

Only cough if you feel the secretions are ready to be cleared. 

When do I stop? 

After two cycles without clearing secretions OR until you are tired. 

How often should I do them? 

If you have an infection you will need to do the cycle several times a day to clear the secretions. Three deep breaths every half hour is a good way to check for secretions and improve ventilation, especially during an infection. 

Adaptations 

The ACBT is a flexible tool. You can do more than one set of deep breaths before huffing. Remember to use breathing to control in between. 

 You need to remember Important information

This patient information is for guidance purposes only and is not provided to replace professional clinical advice from a qualified practitioner. 

Hand hygiene is important factor to consider

The trust is committed to maintaining a clean, safe environment. Hand hygiene is very important in controlling infection. Alcohol gel is widely available at the patient bedside for staff use and at the entrance of each clinical area for visitors to clean their hands before and after entering. 

wallahuaklam.

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Tracheostomy Care at home 3

Management of Tracheotomy Care 3

Bismillahirahmanirahim...

Physiotherapy Care for Tracheotomy.

• Must conduct a thorough assessment of patient at the start of visit
• Observe for signs of hypoxia, infection, excessive secretions, pain, etc
• Examine trach tube, any attached tubing and equipment, as well as stoma site
• Observe for redness, purulent drainage, and abnormal bleeding around the stoma – note the amount, color, consistency, and odor of secretions
• Auscultate breath sounds
• Ensure that appropriate emergency trach supplies and CPR equipment is at bedside
• Be aware of when and why the trach was inserted , how it was performed, the type and size of tube inserted
• Please note:  When a trach is inserted, the natural warming, humidification and filtering of inhaled air (from nares / mouth) is lost.  Therefor it is essential to provide an alternate form of humidification.

Tracheostomy Humidification

As mentioned previously, the nose and mouth provide warmth, moisture and filtration for the air we breath.  Having a tracheostomy tube, however, by-passes these mechanisms so humidification must be provided to keep secretions thin and to avoid mucus plugs

Types of tracheostomy humidification systems

1. Heated humidification (increased heat and water vapor inhaled) –
2. Ambient or cold water humidification
3. Heat and moisture exchangers
4. Stoma protectors
5. Heat moisture exchanger (attached to the outside of a trach tube for long-term trach patients) – looks like a t-tube attachment

Humidification examples

Mobilizing Secretions under Physio Care

• Many trach patients have acute or chronic disease that predispose to stagnation of secretions
• Frequent repositioning, deep breathing and coughing, chest physiotherapy, postural drainage, oral and parenteral hydration and supplemental humidification all help to thin and mobilize secretions
• Tubing from an external moisture source accumulates moisture and will need frequent draining – ensure the tubing is positioned LOWER than the patient to avoid aspiration risk!

Suctioning Care

• Necessary for all trach patients to remove secretions and assess for airway patency
• Acute care patients need to be assessed every two hours (teach family members)
• Routinely done 2x / day, but more often if needed – particularly a newly placed tracheostomy or when there is infection present
• Suctioning activates psychological and physiological reflexes that make the experience both uncomfortable and frightening
• Precaution– severe hypoxia, cardiac arrhythmias, and even cardiac arrest when the airway is occluded by the catheter and air is simultaneously sucked out the lungs.

Indications for Suctioning

1. Dyspnea:  Flared nostrils, chest retractions and/or prolonged wheezing
2. Noisy breathing
3. Cyanosis and clammy skin
4. Restlessness and agitation
5. Copious secretions; moist cough
6. Low oxygen saturation
7. Increased peak inspiratory pressure on mechanical ventilator

Procedure for suctioning

1. Place patient in semi-fowler’s position
2. Select appropriate sized suction catheter
3. Hyper oxygenate BEFORE each suction pass (exceptions to hyper oxygenation are children and patients with long-term tracheostomies)
4. Insert catheter to a pre-measured depth or (to point of resistance if deep suctioning)
5. Apply suction on withdrawal while slowly removing suction catheter
6. Limit suctioning to 5 seconds for pre-measured depth and 10-15 seconds for deep suctioning
7. Use suction pressure between 80 – 120 mmHg
8. Limit suctioning to 3 passes and discontinue if HR drops by 20; increases by 40, produces arrhythmias, or decreases 02 < 90%
9. It’s important to note:  suction mouth AFTER trach suctioning to remove secretions ABOVE CUFF.  DO NOT CONTAMINATE the trach be going from mouth back to trach
10. Reassess the patient’s condition after suctioning and recommence oxygen therapy as soon as possible, ideally within 10 seconds of completing suctioning.  

Tracheostomy Ties

• To lower the risk of a new trach tube accidentally dislodging, ties are usually not changed within the first 24 HOURS FOLLOWING INSERTION; thereafter, ties are generally changed daily
•  To lower the risk of accidental decannulation (the trach tube coming out) the tie changes should be performed by two people or with new ties secured BEFORE old ties are removed.
• Various ties are available on the market today such as velcro tape and twill tape.  Maintain two finger breaths between patient neck and ties for ease and comfort.

Maintenance of the inner cannula

• The majority of trach tubes have inner cannulas that require cleaning one to three times daily unless they are disposable
• Use sterile technique to clean the reusable cannula with ½ strength hydrogen peroxide and normal saline or just NS
• Reinsert and lock back into place within a 15 minute time frame

Trach cuff pressure

• Cuff pressure (balloon) should be maintained between 20 to 20 mmHg of pressure via a manometer – should be assessed daily;
• if you don’t have a manometer measuring device – check with the patient/family – to evaluate how many cc’s of cuff pressure they have been utilizing (generally 5-8 cc) depending on trach size
• With a stethoscope placed on the neck, inflate the cuff until you no longer hear hissing; deflate the cuff in tiny increments until a slight his returns.

Possible Trach Complications

• Can arise the first few days or within several weeks; initially, the most common complications are:
• Inflammation and edema of the trachea
• Infection and abscess of stoma and/or pulmonary tree
• Bleeding associated with suctioning
• If humidity is insufficient, mucous membranes dry out and the irritation of an inserted catheter will cause small amounts of bleeding during routine suctioning
• Long-term complications from the presence of a trach are due to tracheal scarring and erosion
• Stenosis, the narrowing of the trachea from scar tissue occurs in 5 to 15% of patients
• Scarring can occur at the stoma, the cuff site, or at the point where the distal end of the tube presses on the tracheal wall – possible granuloma….
• Stenosis:  fairly common complication of trach patients, but are not usually significant enough for surgical intervention unless it narrows the airway by more than 50% 
• Ulceration and scarring:  may occur with prolonged exposure to a trach tube; treatment may be:  serial dilation; endoscopic excision; anterior cricoid split or laryngotracheoplasty (balloon open)
• Fistula formation:  may take months to develop.  The constant pressure from a poorly fitted trach tube, excessive cuff volume, and/or nasogastric feeding tube all contribute to tissue necrosis.  A fistula can develop between the trachea and the esophagus or can grow into the wall containing a major artery
• Aspiration of gastric contents:  is the consequence for one path of erosion; hemorrhage results from the other.  If your patient is coughing and choking during meals, and trach cuff inflation requires increasing amounts of air, your patient may have a tracheal-esophageal fistula.  A patient with a fistula should be NPO and evaluated for surgery
• Decannulation:  trach tubes are discontinued surgically or through a transition process of intermittent trials; the trach tube is capped or plugged for lengthening periods of time until the patient can tolerate if for 24 hours; during these times, patient should be closely observed for respiratory distress; systematic downsizing of tube may also be used for the weaning process; always assess your patient’s risk for aspiration BEFORE removing tube; patient should be NPO at least 4 hours prior to removal; once tube is removed, an occlusive dressing should be placed over the remaining stoma to form a seal so that patient can breath normally through the mouth and nose; once removed, the stoma normally closes by itself, if not, minor surgery will be done to close it; patient should be inserted to apply gentle pressure over the stoma dressing when coughing or speaking to aid in the stoma closure; dressings need to be CDI.

Home Trach Care

1. Patient and family education normally starts in hospital setting
2. Initial care may consist of:
3. Warm compress to the incision site to help relieve discomfort
4. Humidified air
5. Wearing a scarf over trach opening to keep dry and clean
6. Follow up with Dr. for any concerns or changes

Patient Instructions

Trach patient’s avoid:

1. Deep bathing water
2. Fine particles such as powders, chalk, sand, dust, mold and smoke
3. Loose fibers and fair found on fuzzy toys and pets
4. Persons with contagious illnesses
5. Cold air and wind
6. Portable suction equipment is available for travel and should be tested PRIOR to use

The sharing of this info is easy for family members and patient to understand how to learn and also understand a Tracheotomy care ,it will give some clear picture to take care and also to prevent any complication after the procedure of Tracheotomy. wallahuaklam.

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Tracheotomy Care at home 2

Management Of Tracheotomy Care 2

Bismillahirahmanirahim, as i mentioned in my last post entry , here i will continue about the info regarding management of tracheotomy .

Endotracheal Tube Verses Tracheostomy Tube

A variety of tracheostomy tubes are available, depending on the patient’s specific needs.  Tracheostomy tubes vary in size, composition, number of parts, and shape.  Trach tubes may be made of metal, PVC material, or silicone and will differ accordingly in the degree of flexibility they provide.  They are either disposable or reusable.  

Cuffed Tracheostomy Tube

Consists of three parts:

1. Outer cannula with an inflatable cuff and pilot tube
2. An inner cannula
3. An obturator

• Cuff trach tubes are generally used for patients who have swallowing difficulties or who are receiving mechanical ventilation. 
• Disposable and reusable trach tubes are both available – and can be custom made if needed.
• The outer cannula has an inflated cuff that keeps the airway open.  When inflated, this tube seals the airway and prevents aspiration of oral or gastric secretions.  The cuff directs air through but not around the tube.  It is commonly used when mechanical ventilation is required, to provide a closed airway system.
• The inner cannula of the cuffed tube has a universal adaptor to use with a ventilator and other respiratory equipment.  The inner cannulas can be removed, cleaned, and reinserted, unless it is disposable.  The inner cannula fits inside the outer cannula.  It has a lock to keep it from being coughed out, and is easy to remove for cleaning. 
• The obturator has a rounded tip for smoothly inserting the outer tube and avoiding trauma to the tracheal wall.  It is important to keep the obturator near the beside in case of an emergency.  It is used to insert the tracheostomy tube.  
• The cuffed tube with disposable inner cannula is used to obtain a closed circuit for ventilation; cuff should be inflated when using with ventilator – just enough to allow for minimal airleak; should be deflated when/if a patient uses a speaking valve; cuff pressure needs to be checked twice daily; inner cannula is disposable.  The same aforementioned items pertain to a cuffed tube with reusable inner cannula with the exception that the inner cannula is NOT disposable – it can be reused when cleaned properly and thoroughly.

Cuffless tubes

1. Rarely used in acute care settings
2. More suitable for long term ventilation
3. Cuffless tube is usually double-lumen – patient must have effective cough and gag reflex to prevent aspiration risk

• Non-cuffed or (cuffless) trach tubes are used to maintain a patient’s airway when a ventilator is not needed. 
• Also used for patients who are ready for decannulation.  Patient may be able to eat and may be able to talk without a speaking valve

Fenestrated Tube

• Have an opening on the posterior wall of outer cannula – allows for air flow through the upper airway and trach opening;
• Allows patient to speak and produce a more productive cough
• Often used during weaning process

Used for ventilated patients who are not able to tolerate the speaking valve; there is a high risk for granuloma formation at the site of the fenestration (hole).  There is a higher risk for aspiration of secretions; it may be difficult to ventilate the patient adequately

Communication and Tracheostomies

Some trach tubes  are designed to allow patients to speak

Patients being weaned off trach tubes may have either a cuffless, fenestrated tube or a trach button that does not extend into the trachea enough to restrict airflow past the larynx

For long-term Trach patients

Speaking is possible with these options:

A fenestrated inner cannula inside a cuffed outer cannula – allows for speech when cuff is deflated (some tubes expand on inspiration and deflate on expiration versus manually deflated cuffs)

A tracheostomy speaking valve is a device that attaches to the trach tube – it contains a diaphragm that opens on inspiration and closes on expiration so that air is exhaled through the vocal cords and upper airway – the cuff must be COMPLETELY deflated during speaking valve to allow for exhalation through the upper airway

A speaking trach tube forces air or oxygen from an outside source to flow across the vocal cords, independent of the airflow within a closed system created by a cuffed trach tube.  The patient has control over this air line with a thumb port. 

will continue to Management Tracheotomy 3, wallahuaklam.

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Tracheotomy Care at home 1

Management of tracheostomy care 1

Bismillahirahmanirahim , The term “tracheotomy” refers to the incision (otomy = opening) to provide an airway and allow for removal of secretions from lungs.  Breathing is accomplished through the tracheostomy rather than through the nose and mouth.  A tracheostomy can either be temporary or permanent.

What is Tracheostomy Facts ?

Tracheotomy is a surgical procedure that creates an opening in the cervical trachea (windpipe) allowing direct access to the breathing tube – rarely done as an emergency – secondary to oral or nasal intubation which is must faster and less complicated when managing respiratory arrest.

Why is a Tracheostomy performed?

• To bypass obstruction
• To maintain an open airway
• To remove secretions more easily
• To oxygenate and/or provide mechanical ventilation on a long-term basis

 Types of patients requiring tracheostomies?

• A comatose patient
• A patient with cancer of the larynx or neck
• Blockage of airway
• Inability to swallow or cough
• A burn patient with inhalation damage
• A COPD patient on mechanical ventilation
• A pediatric patient with a congenital airway obstruction
• ALS patients
• Plegic patients

Tracheostomy Anatomy

The tracheostomy can be performed in the OR or at bedside under moderate sedation.  The tracheostomy is usually formed between the second and third or third and fourth tracheal cartilages.

Percutaneous dilatational tracheostomy (PCT or PDT) is done at the patient’s bedside, usually in the ICU setting.  The procedure generally takes 15 minutes or less…bedside procedure (1/4 of patients) are contraindicated in a quarter of the patients – mostly due to anatomical irregularities or coagulation problems.

Landmark Of tracheostomy ?

Definition of Terms in Tracheostomy.

• Decannulation:  Removal of a tracheostomy tube
• HME:  Heat, moisture exchange (have pictorial)
• Humidification:  the mechanical process of increasing the water vapor content of an inspired gas
• Stoma:  a permanent opening between the surface of the body and an underlying organ (trachea and anterior surface of neck)
• Tracheal suctioning:  a means to clear the airway of secretions or mucus through the application of a negative pressure via a suction catheter

Temporary Tracheostomy versus Permanent Laryngectomy

Temporary:  THE UPPER AIRWAY WILL REMAIN PATENT IF THE TRACH TUBE WERE TO BE DISLODGED

Permanent:  THE LARYNX  IS REMOVED AND AN ARTIFICAL TRACHEOSTOMY IS CREATED – NO CONNECTION BETWEEN THE PATIENT’S UPPER AIRWAY AND THE TRACHEA ITSELF

Risks or complication of tracheostomy .

• Medication reaction
• Uncontrollable bleeding
• Respiratory problems
• Possibility of cardiac arrest
• Pneumothorax
• SC and/or mediastinal emphysema
• Tracheo-oesophageal fistula (development of a small connection between trachea and esophagus)
• Infection

Post procedural trach care:

The first days following tracheostomy are especially uncomfortable for the patient.  Namely – adjusting to the trauma of surgery, pain of a fresh incision, presence of a foreign object in the trachea, and the inability to communicate through speech. 

Patients commonly report choking sensations – generally takes one to three days to adapt to breathing through a trach tube

Potential Complications with Long-term Tracheostomy

• Thinning (erosion) of the trachea (trachemalacia)
• Development of granulation of tissue (bump formation in trachea
• Narrowing or collapse of the airway above the site of tracheostomy
• Once tracheostomy tube is removed, the opening may not close on its own
• Dysphagia; airway obstruction from secretions;
• Tracheal ischemia and necrosis

Higher risk for PCs exist for the following patient population:  children (newborns, infants); smokers; ETOH abusers; DM; immunocompromised patients; persons with chronic disease or respiratory infections; persons taking steroids or cortisone

Continued Assessment/SE after tracheostomy placement

• Subcutaneous emphysema (SCE) around stoma – air escapes into the tracheostomy incision creating SCE; generally of no clinical consequence – but can be palpated around the stoma site
• Excessive manipulation of the trach tube during coughing or suctioning can break improperly secured ties and dislodge the tube – (within the first 48 hours the freshly created stoma has a potential to close shut, constituting a medical emergency) – to minimize this risk, trach ties are not usually changed for 24 hours 
• First tube change is generally done by a physician after approximately one week (should have detailed Dr’s orders to always have a spare trach tube on hand – size should be indicated

Insha Allah  , in next blog entry i will continue another info regarding a tracheostomy  Care , its important for us to understand regarding a tracheostomy care for easy to manage and also give some info on that matters. wallahuaklam.

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Batuk normal dan tidak normal.

Apakah Itu Batuk ?

Bismillahirahmanirahim,

Semalam petang saya tersedak dan terbatuk ketika minum nescafe ,nak kata orang rindu kat saya tak tahulah (kata orang dulu dulu) ,Tapi tahukah kita apakah itu batuk yang sebenarnye? Batuk merupakan tindakan refleks/protective reflex terjadi apabila saluran penafasan kita tersekat atau terganggu. Tujuan batuk adalah untuk membersihkan saluran  pernafasan supaya kita dapat bernafas dgn lebih selesa. 

Jenis & ciri-ciri Batuk:

1) Batuk tidak berkahak

• Selalunya pesakit akan merasa kering, gatal/perit di tekak
• rasa gatal yg kering di tekak ini akan mengakibatkan batuk yg mengganggu tanpa mengeluarkan kahak atau lendir
• Selalunya ianya disebabkan oleh jangkitan virus atau tindak balas akibat alahan dan kemasukan benda asing di saluran pernafasan  dan biasanya ia akan pulih sendiri

2) Batuk berkahak/chesty cough 

• batuk  dan mengeluarkan  dan penghasilan kahak menandakan jangkitan dlm paru2 seperti bronchitis and pneunomia.
• Sealunya kahak yang terhasil berwarna hijau, kuning spt karat. Kekadang ada darah dlm kahak(hemoptisis) merupakan tanda penyakit yg serious. seperti (TB atau Kanser Paru Paru)

Tahukah Anda dengan Kahak seseorang itu boleh mengenali masalah yang dialami

Carta Warna Kahak

1)Kahak berwarna putih dan jernih/lebih cair

• tidak menunjukkan sebarang penyakit

2)Kahak Berwarna putih, berbuih dan byk

• terdpt pada pesakit bronkitis kronik dan mrk yg merokok serta terdedah kepada asap serta bahan kimia.

3)Kahak Berwarna hijau, coklat atau kuning

• Menandakan adanya jangkitan dlm paru2 seperti bronkitis, pneunomia atau jangkitan didlm saluran penafasan

4)kahak berdarah atau Karat

• menandakan adanya penyakit dlm paru2 seperti (karsinoma/cacinoma, batuk kering/tuberculosis, embolisme paru2/pulmonary embolism .

Apakah Fungsi Kahak ini

Tahukah kita perparu kita menghasilkan satu mekanisma perlindungan dimana bahan pencair lendir adalah bahan yg membantu tubuh badan kita,dalam membantu untuk menapis dan juga mengeluarkan habuk, kuman dan bendasing yg terperangkap dari saluaran penafasan.  lendir ini juga membantu mengurangkan kesakitan peparu kita ketika batuk dan adalah penting ianya merupakan salah satu sistem pertahanan tubuh untuk mencegah jangkitan, lendir ini akan menjadi masalah apabila ianya dihasilkan dalam kuaniti yang banyak , bertukar warna dan juga diikuti dengan sukar bernafas dan demam.

Tips Untuk mengatasi Masalah batuk dan Kahak.

1)Cara yang mudah adalah tingkatkan kelembapan udara dgn alat pelembap, pengewap  or sedut udara yg berkelembapkan tinggi. Ia mencairkan rembesan bronkus atau kahak.Sebagai contoh penggunaan nebulizer , atau penggunaan Wap Panas 

2)Perbanyakan minum air suam

3)kurangkan makanan yg menyebabkan byk lendir spt

• bahan tenusu
• makanan yg diproses byk kali(seperti minyak yg lama digunakan)
• daging
• makanan remeh
• gula pasir
• buah2 manis
• makanan dr tepung seperti roti putih atau biskut
• Makanan unsur kekacang

4)Jauhkan diri dari asap rokok , merokok dan juga terdedah kepada asap asap kenderaan. 

5 Banyakkan lakukan senaman Pernafasan 

6) Lakukan Self Postural drainage bagi membantu mengeluarkan kahak

Rawatan Buang Kahak,

Apa yang saya kongsikan di sini lebih kepada info tentang batuk dan juga kita boleh menilai jenis kahak yang terhasil disebabkan oleh batuk ini 

wallahuaklam.

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