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The endotracheal tube malposition (TOT) is a complication that occurs in 12 to 15% of intubations performed in the Critical Care Unit. The bevel of the endotracheal tube should be located 4-5 cm. above the carina, equivalent to the level of the third or fourth thoracic vertebra. Must be documented insertion depth, distance in inches at the upper incisor or level of the lips in a patient without teeth. Also, once placed, you must mark the TOT, preferably at the upper incisor or failing that, at the level of the lips to get an idea of the correct depth.
The position of the tip or tip of the TOT is dependent on the position of the head and neck. Descends forward flexion TOT on average 1.9 cm. and backward extension tip raises a similar distance. rose of sharon Chest radiography should always be performed after primary and secondary tube placement confirmation and obviously in a patient stabilized cervically. In patients with TOT placed in the airway, chest X-ray (anteroposterior view) only tells us how many centimeters from the carina is the tip or distal end of the tube, and if it is moved to the right bronchus, but no so assures us that it is within rose of sharon the airway.
Primary confirmation is performed by auscultation rose of sharon of the chest. Secondary confirmation is through detection of CO2 in expired air. The depth at which the TOT is in man must be 23 cm. and 21 cm. in women, though the depth should always be assessed rose of sharon individually, particularly considering the size of the patient.
When TOT hernia, this situation is associated with symptoms of acute airway obstruction with ETCO2 immediate drop, followed by the% decrease SatO2 with concomitant increase in the airway pressure and cycling failure of the respirator, objectifying auscultatory silence in both lung fields and increased resistance to manual ventilation if the herniation is complete (extubation). Case
In his personal history consisted allergy to penicillin and derivatives, smoking 30 cigarettes a day, chronic alcoholism, rose of sharon hiatal hernia, gastroesophageal reflux, liver enol, predominantly subcortical atrophy and cerebellar atrophy secondary to chronic alcoholism, cholelithiasis, infectious mononucleosis to 10. He said numerous income in psychiatry, the last in September rose of sharon 2013 with a discharge diagnosis of alcohol withdrawal, depressive disorder and dysfunctional personality traits. As surgical resection antecedent pilonidal rose of sharon cyst was performed.
The pre-episode vitals were: TA 120-55 mmHg, HR 90 bpm.. in sinus rhythm, temp 36.8 C (requiring mechanical ventilation controlled by vol