Heart Disease prevention

Heart Disease Prevention 

Bismillahirahmanirahim , today i feel to type a topic regarding how to prevent a heart disease.
Everybody know a Heart disease is one disease that has the potential to cause death. But that does not mean we should accept it as fate, because as human beings we are given the right to strive (initiative), one of the supreme effort that preventing a heart disease.

To all readers, there are many causes of heart disease or risk factors that we can not change such as age, gender, and family history. But there are still many risk factors that we can change so we could do the prevention of heart disease with a healthy lifestyle that the most important is to understand the source and the way to prevent it.

So lets discuss on how to prevent a heart disease. We know there are some ways that can help reduce the risk of heart disease, such as lowering blood pressure and blood cholesterol levels. Here are some tips to prevent heart disease:

Healthy food or a balanced diet of heart-
healthy foods are foods that are low in fat and high in fiber, including fresh fruits and vegetables, and grains. In addition we also have to limit the amount of salt in our food, which was no more than 6gram a day because too much salt increases blood pressure. Six grams of salt is about a teaspoonful. They should also know, there are two types of fat, namely saturated and unsaturated fats. We should avoid foods that contain saturated fat because it increases blood cholesterol levels. Foods high in saturated fats should be limited, among others: the sausage and chunks of meat fat butter pork fat hard cheese, cakes and biscuits foods containing coconut (bersantan) or palm Avoid or limit food sources high trans fats, include: Fried-fried bakery products food lightweight packaging Crackers However, a balanced diet should include a small amount of unsaturated fat, which will help to reduce cholesterol levels. Foods high in unsaturated fats include: Fish oil Avocado Nuts and seeds Sunflower seeds, olive oil and vegetable oils

Do not smoke or use tobacco
smoke or use tobacco in any form is one of the most significant risk factor for developing heart disease. The chemicals in tobacco can damage the heart and blood vessels, causing narrowing of the arteries (atherosclerosis). Atherosclerosis can eventually lead to coronary heart disease.

Make sure to Maintain ideal body weight 
ideal weight is also important to reduce the risk of heart disease, weight adan know whether it ideal weight calculator.

To Have Adequate and quality sleep
Lack of sleep can be harmful to health. People who do not get enough sleep have a higher risk of obesity, high blood pressure, heart attacks, diabetes and depression. Most adults need seven to eight hours of sleep each night.

Be Active in life style
Combining a healthy diet with regular exercise is the best way to maintain a healthy weight. Having a healthy weight reduces the risk of developing high blood pressure. Regular exercise will make your heart and circulatory system becomes more efficient, lowering cholesterol levels, and also to maintain a normal blood pressure.

Make a Habit Regular health checks 
High blood pressure and high cholesterol can damage the heart and blood vessels. Without first doing the examination, one would not know that they have this condition. Therefore, the examination is very important.
Blood pressure: Optimal blood pressure is less than 120/80 millimeters of mercury (mmHg). Someone who has proved to have hypertension or high blood pressure control routine and then have to take medication as prescribed, because if high blood pressure is left to be harmful to the heart. Cholesterol levels: Adults should check your blood cholesterol at least once every five years beginning at age 20 if they have risk factors for heart disease, such as obesity or high blood pressure. If healthy, then it can start to do a routine check of cholesterol at the age of 35 years for men and 45 years for women.
Diabetic Level :Because diabetes is a risk factor for heart disease, it is necessary to also check the blood sugar whether or not diabetes. Depending on risk factors, such as being overweight or a family history of diabetes, the doctor will recommend early screening for diabetes. If your weight is normal and you do not have other risk factors for type 2 diabetes, the American Diabetes Association recommends screening begin at age 45, and then retesting every three years. For those who already have diabetes then it should exercise restraint as scheduled routine so that blood sugar control.

So this tips is simple and i am sure everybody is concern their health status ,i believe those are some preventive measures for heart disease that we can employ to minimize the occurrence of heart attacks in the future. Wallahuaklam.

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Jari tangan berbunyi

Bunyi Sendi Jari

Bismillahirahmanirahim , hari ini agak sunyi sikit di tempat kerja saya , mungkin sebab Chinese New Year akan jatuh hari sabtu ini , maka ramai pesakit pantang untuk datang ke hospital terutama pesakit cina.
Dalam blog saya hari ini saya nak kongsikan tentang , letupkan Jari , ada yang panggil Retak sendi ia adalah merupakan  satu fenomena yang menarik dan kurang difahami oleh kalangan masyarakat kita sehingga menimbulkan terlalu banyak teori tentang mengapa sendi jari ini berbunyi  pop jika dibengkokkan maksimum , tetapi punca sebenar masih lagi masyarakat tidak mengetahui bagaimana ianya terhasil..

Melalui pengalaman saya sebagai ahli fisioterapi saya ingin menerangkan kepada umum tentang fenomena membunyikan sendi ini dari segi kajian perubatan membunyikan setiap sendi sendi di anggota badan terutama jari ianya tidaklah merbahaya dan memberikan kesan yang buruk tetapi jika menghasilkan letupan  sendi ini mula mendatangkan kesakitan dan juga kelemahan pada bahagian yang dibunyikan ianya haruslah diberhentikan serta merta .

Sekali lagi ingin saya katakan melalui kajian perubatan membunyikan sendi tidak merbahaya dan juga tidak memberikan apa apa manfaat kerana ianya masih belum terbukti berbahaya kepada tubuh badan manusia . Banyak teori yang terhasil tanpa kajian mendalam mengatakan bila kita selalu membunyikan sendi jari maka jari kita akan mudah terkena arthritis.Teori ini tidak benar , jika anda belajar apa itu arthritis banyak faktor faktor yang memungkinkan perkara ini terjadi. Sebab itu apa bila pesakit bertanya saya hanya memberitahu jika ianya tidak menyakitkan anda teruskan kerana ada pesakit memikirkan bila membunyikan sendi di jari mereka merasakan sesuatu kelegaan , tetapi bagi saya ianya lebih kepada perasaan pesakit itu sendiri.

Disini saya ingin ceritakan secara ringkas bagaimana bunyi itu dihasilkan di dalam sendi, Bunyi pada bahagian sendi ini adalahdisebabkan oleh tekanan yang berlawanan arah dimana ianya menarik gas nitrogen sementara ke dalam sendi, apa bila berlaku mampatan pada bahagian sendi deperti jari dibengkokan secara kuat maka gas ini akan dilepaskan dan bunyi POP terhasil.Selain itu bunyi sendi juga boleh didengar jika tendon pada sendi bergesel antara satu sama lain kerana penyesuaian kecil di laluan meluncur mereka. Ini boleh berlaku atas faktor usia dan juga diatas perubahan tindakan yang berlaku serta merta seperti dari bersila terus berdiri.

Ruang Gas yang berada pada sendi jari sebelum diletupkan dan selepas yang diambil melalui pengimejan gambar.

Saya ingin sarankan dan juga memberitahu jika bunyi sendi ini disertai dengan rasa sakit, mungkin ada asas keabnormalan struktur sendi, seperti rawan longgar atau kecederaan kepada ligament. Sesetengah pesakit  yang menghidap masalah arthritis , Gout , Bursitis dan juga Osteoarthritis bunyi yang terhasil adalah menunjukkan ketidak abnormalan pada permukaan sendi dan tisu itu sendiri , selalunya ia disertai dengan bengkak dan juga rasa sakit.

Inshaallah , saya harap penerangan serba ringkas ini memberikan sedikit gambaran dan juga pemahaman kepada umum agar memahami asas tubuh badan manusia ini .wallahuaklam.

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Chair exercise

Exercise on Chair in 2 Steps

Bismillahirahmanirahim , today i want to share a very simple and effective exercise for your body , its call exercise on chair.
what your need is your self and a dining chair..

1st Step .

Get ready. Focus on posture: Sit on your sit bones (if you sit on your hands, you can probably feel them) rather than your tailbone. Tighten your belly (think about bringing your belly button toward your spine), lift the rib cage, hold your neck long and straight, and tuck your chin down and back so you feel a long stretch on the back of your neck. “Feel like you have a string pulling up from the top of your head

2nd Step 

March in place. While you’re holding an upright posture, march in place with your seat firmly planted. Swing the opposite arm as you march each foot forward, Sitting Marching exercise is a fun way , safe and easiest way to gain strength, flexibility and effective in controlling your blood glucose, you even do it at home and in front of tv.

so its simple , effective  and save with no harm , i would say there will no be excuse for you to keep your body fit and health . wallahuaklam.

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Technique to massage your Nasal Congestion and Sinus.

A simple Sinus + Nasal Congestion Massage technique.

Bismillahirahmanirahim, when you get a sinus it will cause a lot of trouble for your to breath as your nose will be immediately to block and congested, here i want to sharing a simple way and technique to massage your sinus problem.

This method i can say is the one of pattern a Relieve congestion the old-fashioned way.
Its say that because  we never use any medicine or stimulants,the preparation of this technique just you and your fingers.I believe to say a self-massaging is one of the easiest way to do and also effective. Here are three  type of massages that you can do in any time .

• First step is wash your hand clean and take both index fingers  with place them on upper side of the eye , its just above the brow as show in picture below.

•  In outward circles, start massaging the sinuses around  that area with your fingers gently and try to do this for around 20 to 30 seconds.

• Second step is you take both index fingers and place them right below your eyes. Again, using outward circles, massage the sinuses around your eyes using your fingers. Make sure you take a time to do this for 20 to 30 seconds for seeing the effect.
  

• And The third step is Finally,  Using moderate pressure, use your both thumbs to massage from the middle of the forehead and towards your ears.Remember as i say before try to do this for 20 to 30 seconds. Repeat the massage again, or until your sinuses are adequately relieved.
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This steps is one of the alternative home treatment that you can use , it safe from drugs and the most important thing its not harm you , only the thing must remember is stop immediately when you feel experience of pain if using this technique. Wallahuaklam.

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Best technique to wash the face.

The best way to wash the Face


Bismillahirahmanirahim , How to wash your face ?,there are also tips and not just washed water or use a face wash. Most people make the mistake of typing this activity. For men may be rare because nearly 90% of them did not do so, but for women, wash your face is like a bath, when not done in a single day feels something is missing in them.
Everything concerning the actual facial beauty treatments there is knowledge, and the most worthy of reference is from the experts who are experts in their field. But since there are several sites with women who already do share previously as a physio i wanted to take the role as a mouthpiece alone in this regard. In that sense, the core material will be delivered in simple language, while adding related reviews that are still a matter of beauty.

How to Wash Face and Natural Face Wash

Below  this blog it will be disclosed a few errors as well as tips on caring for them in the face to look brighter, free of dull and whiter than before.

Here The simple Tips you can follow.

1. Get rid of hair from the face - Previously, keep the hair that fell in the face placed and fastened to the back first. Functions that do not interfere with our activities when washing the face.

2.Clean your face with warm water - To pores on the face can be open and the face becomes moist then it should be soaked in warm water before use.

3. Don't forget to , wet and wash hands well of water.

4.Then start cleaning the face by first taking a little cleanser is then rubbed on hand to look frothy. Then, gently wash your face in a way rubbed gently twist and massage it a bit slowly. The goal for the easy dirt out of the pores of the face

5. Once clean, let stand a few seconds and then rinse with cold water until no residual soap left. Intended use cold water so that the pores are closed again after being washed circuitry warm water.

6.Furthermore, dry using a soft towel and is new (not used previously) being contaminated with germs again and the skin can be really dry.

7.Lastly, stay using special face moisturizer, can use the product Provided that matches your skin type.

Healthy skin is the result of good care and perfect technique that are using by ourselves. Hopefully this tips will guide you the easiest way to take care of your face. wallahuaklam.

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What is the Myalgia

Myalgia.

Bismillahirahmanirahim , Myalgia is the medical language of muscle pain, comes from the Greek, namely myo meaning muscle and algos which means pain. Therefore, myalgia means pain in the muscles or in the language of the people called by sore.The entire body is covered muscle, the muscle pain also can occur anywhere. Myalgia is a very common complaint, and almost everyone has experienced myalgia, muscle pain although the location varies, depending on the activity and its causes

For example, the office workers who often sit for hours in front of a table or a driver, often complain of muscle pain in the lumbar region. Construction workers or workers often complain of muscle pain in the shoulder area. The shopkeeper or sales often complain of muscle pain in the lower leg area.

What are the symptoms of myalgia?
Other symptoms that may accompany myalgia include:

•  Fever
•  swelling at the site of pain
•  Redness 
• Weakness Pain in the joints of the symptoms above, does not always appear all, this is in accordance with what is causing myalgia, for example when the cause is a common infection such as the flu or DBD, the complaint will be accompanying fever. Whereas when only fatigue, the symptoms of which minuscule only muscle pain and may limp. And so on.

What Causes Myalgia?

Muscle soreness can occur because of muscle at that location tense or stiff. Some things that can lead to painful muscle tension among others:

Too much use (overuse)

Activity is too much, especially using certain muscles, it will cause the muscles become sore. Activities that too many are not comparable with the supply of oxygen from the blood vessels, leading to the buildup of lactic acid in the muscles. Lactic acid is what causes the muscles to become sore.

Trauma or injury

At the time of physical activity with the wrong position can cause muscles to become injured, then painful. Muscle pain arising due to this trauma usually is local or on just one area.

psychological factors

muscle pain also influenced by psychological factors a person. The presence of stress or depression can cause a person to complain of muscle aches.

Disease causes myalgia

Muscle pain can also arise because it is influenced by a person's medical condition or the effect of a particular disease. As an example 

1. The existence of an inflammatory process or infection. If there is inflammation or infection, muscle pain usually spreads to the entire body. For example: when the flu because the virus infection, we can feel pains all over the body.
2. The presence of autoimmune diseases such as Systemic Lupus Erythematosus, Dermatomyositis and Polymyositis.
3. The use of certain drugs, such as statins, anti-hypertensive drugs ACE inhibitors, or narcotic cocaine.
4. Disorders of the thyroid gland, can hypothyroidism or hyperthyroidism.
5. Hypokalemia, where the levels of potassium in the body is low.
6. Fibromyalgia disease, where there is chronic pain.

How To Treat Myalgia?

Muscle aches usually gives good results with treatment that can be done at home. Some things you can do yourself to relieve muscle tension, whether due to trauma or too many activities including:

1. Resting areas of the body that feel pain Using pain relievers available commercially, such as ibuprofen or paracetamol 
2. Using topical creams to relieve muscle tension 
3. cold pack (or use ice water) in the areas of pain to reduce the inflammatory process 
4. Physiotherapy treatment
5. Exercise to relieve stress such as meditation or yoga 
6. not lift excessive burden especially in areas experiencing pain

In general, myalgia is not a serious medical condition, it can heal itself or use self-treatment at home. But if myalgia do not heal, the patient should immediately visit a doctor to look for the main cause of myalgia. Myalgia may be a sign that something is a problem in the body. Some of the conditions that must be considered include:

• Pain does not improve after a few days with treatment at home
• severe muscle pain appear suddenly, without any obvious cause muscle pain accompanied by redness, swelling, or increase in body temperature
• myalgias arising due to insect bites

How to Prevent Myalgia

If myalgia arise due to muscular tension or physical activity, then some steps can be taken to reduce the risk of myalgia, among others: 

• Doing stretching or stretching the muscles before and after physical activity Doing warm up before exercising and cool down afterward 
• Drink plenty of fluids to prevent dehydration, especially in when many activities of regular exercise, such as jogging, cycling, swimming, etc. 
• Avoid constant physical activity for too long. For example during long sitting at the computer or do chores, provide a maximum of 1 hour after a short time in between activities to stretch the waist muscles. 
• Do not stand still for too long, interspersed with the activity of a small walk.
•  Taking supplements or vitamin B complex.

As your info and knowledge ,with  thorough review of the patient's history and a complete physical examination can usually narrow the list of potential what is the causes of myalgia to a manageable few .For persistent or severe myalgia without a known cause, selected testing may be necessary to identify or exclude specific diagnoses and to direct treatment. 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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Poison Food can kill slowly

Common food that can kill you slowly 

Bismillahirahmanirahim , human have a naturally instinct to eat when get hungry ,so the explaination is simple, When we wanted to eat, our goal is of course to overcome hunger, getting pleasure on the tongue and nutrition for the body. For survival and optimal health we know that the body requires the right combination of protein, healthy fats, whole grains, dietary fiber, minerals, and vitamins; But many food 'popular' that actually toxic, containing addictive substances that can kill you slowly without you noticing in your life.
We understand, these foods do not necessarily pose a hazard effects directly but took a long time to finally make the body become weak, susceptible to disease and could eventually die from it. Foods such as these do not need to eat, let alone to get it can cause cancer in future.

So beware of the following 10 foods that science has now slowly proved that could kill you without you know.

1.Alcohol

If you drink this one is certainly all agree that this is healthy. Alcoholic drinks full of calories, this could be the cause of weight gain, poor skin health, and has a relationship with depression. These drinks can cause dehydration because of fluid secreted by the body and  its proving in research that can lead to liver damage if consumed too frequently.



2.Artificial sweeteners

Aspartame is an extreme toxic to the body and is associated with high blood pressure, type 2 diabetes and heart disease. There are over 90 different health conditions affected by aspartame such as loss of vision, seizures, anxiety and depression. Instead of better than sugar, aspartame as an artificial sweetener often used recorded much worse than sugar. Do not worry! You can enjoy fresh sweet healthy drink that is found in fruit or vegetable juice and tea with natural sweeteners such as stevia leaf or honey to add sweetness and micro nutrients.

3.Simple carbohydrates

Refined carbohydrates such as white bread, flour and pasta have little nutritional value and break down into simple sugars quickly. This causes insulin spikes reactions and accidents that can lead to chronic fatigue, weight gain, heart disease, high blood pressure and diabetes type 2. Replace it with complex carbohydrates found in whole grains, fruits are healthier



4.Sugar

Not as sweet sweetness impact. Did you know that refined white sugar turned out to be toxic and lead to weight gain, heart disease, anxiety and type 2 diabetes if taken continuously without regard to a healthy dose. When the heart is polluted with fructose, it can turn into fat and insulin resistance spike in the body leading to diabetes type 2. In fact, there is also a relationship between high insulin produced and breast and colon cancer. Unfortunately, the sugar contained in millions of food products and be a tricky thing to avoid completely. Always read food labels to be consumed!
the choice is  in your hand

5.Cow's milk

Milk is full of saturated fat and contain Bovine Growth Hormone. Cow's milk is known to cause an inflammatory response associated with cancer, allergies and asthma. Milk also interfere with the absorption of nutrients, arthritis and migraine. As an alternative, use organic milk and goat's milk because it does not have the extra hormones and easier to digest. Some experts have stated that cow milk was never really intended to be consumed by humans since been known to lead to some health problems.

6.Potato chips

Acrylamide is a chemical used in many industrial processes such as dyes, paper, plastics, and adhesives. Acrylamide is a substance formed from frying, heating to a high temperature or bake certain plant foods like potatoes and grains with certain amino acids and have been found to cause cancer in laboratory rats. The World Health Organization classifies acrylamide as a "human carcinogen". This substance is contained in chips and French fries were delicious dry it


7.Fast food

Mass production of fast food like instant noodles and fast-food eateries that usually come from outside, was not healthy. Excessive Eating fast food can cause permanent liver damage. Red meat, salt, saturated fat, sugar, preserves all of the compounds to produce a fast food unhealthy that often causes headaches, nausea, vomiting and addiction. It comes easily to take but can cause heavily impact after take.




8.Trans fats

Foods rich in trans fats, most to high-tech food that adds hydrogen molecules to keep vegetable oils solid at room temperature, for example, can be found in processed foods that are fried and packaged. Trans fats increase the lifespan of food (durable), but reduces human life by increasing LDL cholesterol and increase the risk of heart disease and stroke.






9.Bacon

Preserved meat such as bacon and hot dogs are loaded with sodium, nitrate and other bio-toxin. Diligently consume 'meat products' is preserved can increase the risk of colorectal cancer by 21% and can lead to heart disease. One study found that people who ate more than 160 g of meat like this has a chance of 44% more likely to die prematurely of cardiovascular disease or cancer than those who did not.



10.Canned Soup

It's loaded with sodium, sugar and preservatives. Canned soup has been so successful because it looks healthy and practical. Make own soup with fresh ingredients if you really want to eat healthy.





Its easy to make , easy to take and easy the disease to come , the type of food in my blog here its more to make us clear and understand the impact on our health , so as i am say the choice of your health and life is in your hand. wallahuakalam.

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