Kinkin'

I had a full ICU last night. It was managable however - no major disasters , and somehow this week - We had a geriatric ICU on board. Most of our patients are above 70 years of age ! How it came to that , I am not sure - but the person on call during the weekend certainly filled it agely !!

I was called by Cardiac ICU near midnight , telling me they were not able to insert their suction catheter through the endotracheal tube. I went down to have a look because there must be something mechanical that should be corrected easily.

The patient was 1 16 year old girl who just had her op earlier - debulking of nurofibroma. She has this disease called neurofibromatosis
Currently , she has this large tumour encroaching her left lung - effectively she is breathing on only one side of the lung. The surgeons initially wanted to resect most of it but they only managed to take out 10% of the initial 90% planned.

She was on a flexo-metallic tube which is very mobile and flexible. I reckon my colleagues used this in view of her distorted airway - She also had severe kyphoscoliosis which was corrected but still , the trachea was deviated because of the mass.

Hmmmm... i tried it myself and i could not pass through even the smallest catheter through the tube. I looked at the ventilator and it did not show any sign of blockage. It is of common knowledge that flexometallic tubes can be very" flexible" that if the patient bites on it , it will be disfigured.

Called my lecturer and Senior MO on call to have a look. They were quite worried as well , as her physique looks challenging for intubation. Of course , the first thought was to railroad a new tube but unfortunately we were not able to track through either using the bougie or Cook's catheter. Called Prof M up to ask her how was the intubation condition and convincingly she said it was not difficult - Cormack Lehane 1 but of course one has to manipulate one's tube.

We sedated her with propofol and then had a look with the laryngoscope. The cords were visible and we just did it ! Exchanged it tube for tube. And luckily , it was alright. Success !! Hahaha.. Indra laughed at me when i brought the WHOLE DIFFICULT INTUBATION trolley into Cardiac ICU. Well.. better be ready then scrambling in panic isn't it ??


the kinked site..