1. Stomas Ostomies and Home Ventilators By Wesley Rolfson

2. Tracheostomies “Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea” 1 –Often performed for long term ventilation –Inner and outer cannulas –Some have cuffs Endotrachial tubes cause damage to: –Vocal cords –Trachial tissue 1. Jonathan P Lindman, MD Tracheostomy, eMedicine, http://www.emedicine.com/ent/TOPIC356.HTM, 2006http://www.emedicine.com/ent/TOPIC356.HTM

3. Tracheostomies Common Indications –Obstructions –Facial or Neck trauma –Subcutaneous emphysema –Edema –Long Term mechanical ventilation –Chronic Aspiration issues –Preparation for extensive facial or neck surgery –Sleep apnea not treatable by a less invasive procedure

4. Tracheostomies They are prone to respiratory infections Stenosis of tissue around trach tube Erosion of trachea into the esophagus Granuloma –Growth of inflammatory tissue in or around the trachea

5. Tracheostomies and EMS –Caregiver or patient is calling because Cannula is displaced Something is obstructing the cannula Issues with a ventilator Respiratory infection/ congestion Bleeding –Recent tracheostomies are high risk patients Stoma Education issues

6. Treating their Trach. History –Last time changed –Recent illness –Prior trach issues –Native airway? –Past Medical history Breathing –Position Patient –Cough –Suction –Ventilate patient

7. Treating their Trach. Cannula/Obstruction –Cough –Suction –Remove cannula –Entubation Remember –Native airway may still function –You can disconnect the ventilator as long as you can breath for them

8. Entubating a Stoma ****Check with local protocols********Check with local protocols**** Deflate the cuff Remove the cannula Place ET tube 1-2 cm through stoma Inflate cuff until no air is escaping –Do not over inflate Check for placement using standard methods Secure tube using tape

9. Home Ventilators Used for patients –Post surgery –Sleep apnea –Neuromuscular conditions Quadroplegia, muscle weakness, Polio –Parenchymal lung diseases COPD, pneumonia, fibrosis, rheumatoid arthritis, Lupus, sarcoidosis

10. Types of Ventilators

11. Ventilators Common issues –Mechanical failure –Improper use or training –Change in patient condition –Tubing disconnected or obstructed

12. Ventilators and EMS ****Follow local Protocols********Follow local Protocols**** Repostion patient Suction airway Reconnect tubing Take over breathing for patient if needed Get a good history and record information about ventilator (flow and rate)

13. Ostomies Any Surgery that produces a stoma, specifically surgeries that divert the Intestines, Colon or Ureters. –Colonostomy, Ileostomy, Urostomy Common reasons for Ostomies –Cancer, Diverticulitis, Crohn’s Disease, trauma, neurological diseases, genetic defects

14. Ostomies

15. Should have an ostomy bag in place Depending on location of ostomy may produce liquid or solid fecal matter Digestive enzymes may corrode skin around stoma Ostomy site should be pink or red Most pouches can be emptied without removal

17. Ostomies and EMS Common complaints are Cramps, constipation, pain, diarrhea, bleeding, tearing, excess gas Check for skin and systemic infections Assist in emptying ostomy bag as needed Apply a sterile dressing if no ostomy bag found Avoid puncturing ostomy bag –Contents should be considered caustic

18. Bibliography A K Simmonds Risk management of the home ventilator dependent patient, Thorax, 2006; 61 369-371 Cynthia Bissell, Aaron’s Tracheostomy Page, Tracheostomy Complications http://www.tracheostomy.com/care/complications/index.htm updated 05/14/07 http://www.tracheostomy.com/care/complications/index.htm updated 05/14/07 Gary D. Vogin, MD Living with a Colostomy, The Cleveland Clinic 2001 Jan Clark, RNET, CWOCN, Peg Grover, RNET, COLOSTOMY GUIDE, 2004 Jonathan P Lindman, MD Tracheostomy, eMedicine, http://www.emedicine.com/ent/TOPIC356.HTM, 2006 http://www.emedicine.com/ent/TOPIC356.HTM John Nozum, Sleep Apnea: Frequently Asked Questions, http://home.att.net/~jnozum/Trach/FAQ.htm, 2006 http://home.att.net/~jnozum/Trach/FAQ.htm John Prestwich 'I lived in an iron lung for seven years' Technology, November 14 th 2005 Richard Robinson, Breathe Easy Options Offered for Respiratory Care,QUEST, MDA Publications, October 1998, Vol 5 no. 5 Robert S. Porter, M.A., Bryan Bledsoe, D.O., Richard Cherry, M.S. Paramedic Care Principles and Practice Special Considerations Operations, second edition, Brady, Prentice Hall Health, Upper Saddle River, NJ, 2006 p 1:597-600 5:130-131, 5:271-276 Sharon Doty, Tanya White, Victor Segura Frequency, Causes, and Outcome of Home Ventilator Failure, Chest 1998; 114; 1363-1367 UW Department of Surgery, Ostomy Care Service http://depts.washington.edu/ostomy/colo- ileo.html, © 2004.