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Keith D. Lamb trauma-list@trauma.orgSun, 3 Mar 2002 14:40:09 -0500
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This is a multi-part message in MIME format. ------=_NextPart_000_0057_01C1C2C1.51B0C320 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hi Rosann... We are talking about two different things. The "combative" that you = refer to is used "mostly" by pre-hospital folks like yourself...and = sometimes others...for difficult airway issues that prevent you from = combitube with a traditional endotracheal tube.=20 The Double lumen (tracheobroncheal) tube that I am talking about is = intentionally placed in the main-stem bronchus (usually the left) in = such a manner that each lung can be ventilated independent of each = other. It is often used intra-operatively so that one lung can be = "dropped" to make the surgical procedure easier to accomplish. It can = also be used when a specific lung injury/pathology is heterogeneous so = that different ventilation/protective strategies can be adopted for each = lung. This is the "aspect" that I am interested in most. Thanks. keith Keith D. Lamb RCP, RRT Charge Respiratory Therapist Christiana Care Hospital Newark, Delaware ----- Original Message -----=20 From: Rosann Juska=20 To: trauma-list@trauma.org=20 Sent: Sunday, March 03, 2002 5:11 PM Subject: Re: (no subject) I love the Combi tube!!! I often use it instead of an oral or nasal, = if the situation is right. You can not use it for persons under 5 foot, = has a gag reflex, a person who had ingested a corrosive substance of = someone with an esophageal disease such as Cancer, or severe upper = airway bleeding b/c it will pass directly into the lungs once the cuff = has closed off the esophagus. It can be inserted "blindly" which avoids = improper placement. I am not sure if this answered your question, but if = not I can try again! =B8..=B7 =B4=A8=A8)) -:=A6:- =B8.=B7=B4 .=B7=B4=A8=A8)) ((=B8=B8.=B7=B4 ..=B7=B4 -:=A6:-=20 -:=A6:- ((=B8=B8.=B7=B4* =20 Rosann Juska EMT-P/ER Tech/IC "We all take different paths in life, but no matter where we go, we take a little of each other everywhere." --- Tim McGraw "The fate of the wounded rest in the hands of the one that applies the first dressing." -- Nicholas Senn, 1896 ----- Original Message -----=20 From: Keith D. Lamb=20 To: trauma-list@trauma.org ; Respiratory Care Professionals World = Forum ; ccm-l@list.pitt.edu=20 Sent: Sunday, March 03, 2002 7:58 AM Subject: (no subject) How often are folks intubating with double lumen endotracheal tubes = and for what indications? I don't meant intra-op for thoracic = surgery...but pre-op...or post-op...for specific injury/pathology and to = facilitate independent lung ventilation.=20 For what injury/pathology are you seeing this performed most often? = Example parenchymal injury/pathology or bronchus injury.....fistula etc. = When your patient IS intubated in this fashion and each lung is = being ventilated independently.....what kind of strategy do you employ = regarding ventilator modes. Do you synchronize or not. Do you attempt to = use just a little bit of CPAP with the injured side...or some other = strategy. Do you conventionally ventilate the healthy lung and "jet" or = "oscillate" the injured lung? Does tracheal gas insufflation have a role = in this setting? Any thoughts? keith Keith D. Lamb RCP, RRT Charge Respiratory Therapist Christiana Care Hospital Newark, Delaware ------=_NextPart_000_0057_01C1C2C1.51B0C320 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 5.50.4207.2601" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=3D#ffffff> <DIV><FONT face=3DArial size=3D2>Hi Rosann...</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>We are talking about two different = things. The=20 "combative" that you refer to is used "mostly" by pre-hospital folks = like=20 yourself...and sometimes others...for difficult airway issues that = prevent you=20 from combitube with a traditional endotracheal tube. </FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>The Double lumen (tracheobroncheal) = tube that I am=20 talking about is intentionally placed in the main-stem bronchus (usually = the=20 left) in such a manner that each lung can be ventilated independent of = each=20 other. It is often used intra-operatively so that one lung can be = "dropped" to=20 make the surgical procedure easier to accomplish. It can also be used = when a=20 specific lung injury/pathology is heterogeneous so that different=20 ventilation/protective strategies can be adopted for each lung. This is = the=20 "aspect" that I am interested in most. Thanks.</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>keith</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV>Keith D. Lamb RCP, RRT</DIV> <DIV>Charge Respiratory Therapist<BR>Christiana Care Hospital<BR>Newark, = Delaware</DIV> <BLOCKQUOTE dir=3Dltr=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dmomof2preemies@oceana.net=20 href=3D"mailto:momof2preemies@oceana.net">Rosann Juska</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3Dtrauma-list@trauma.org=20 href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> = </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Sunday, March 03, 2002 = 5:11=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: (no subject)</DIV> <DIV><BR></DIV> <DIV><FONT face=3D"Goudy Old Style" color=3D#008080>I love the Combi = tube!!! I=20 often use it instead of an oral or nasal, if the situation is right. = You can=20 not use it for persons under 5 foot, has a gag reflex, a person who = had=20 ingested a corrosive substance of someone with an esophageal disease = such as=20 Cancer, or severe upper airway bleeding b/c it will pass directly into = the=20 lungs once the cuff has closed off the esophagus. It can be inserted = "blindly"=20 which avoids improper placement. I am not sure if this answered your = question,=20 but if not I can try again!</FONT></DIV> <DIV><BR>=B8..=B7 =B4=A8=A8)) = -:=A6:-<BR> =B8.=B7=B4=20 .=B7=B4=A8=A8))<BR> ((=B8=B8.=B7=B4 = ..=B7=B4 -:=A6:- <BR> =20 -:=A6:- ((=B8=B8.=B7=B4* =20 = <BR> &nb= sp; =20 Rosann Juska</DIV> = <DIV> &n= bsp; =20 EMT-P/ER Tech/IC<BR>"We all take different paths in life, but no=20 matter<BR> where we go, we take a little of each other=20 everywhere."<BR>--- Tim McGraw</DIV> <DIV> </DIV> <DIV>"The fate of the wounded rest<BR>in the hands of the one = that<BR>applies=20 the first dressing."<BR>-- Nicholas Senn, 1896<BR></DIV> <BLOCKQUOTE=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #008080 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dkdlamb@prodigy.net = href=3D"mailto:kdlamb@prodigy.net">Keith D.=20 Lamb</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3Dtrauma-list@trauma.org=20 href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> ; = <A=20 title=3DRC_WORLD@LISTSERV.IUPUI.EDU=20 href=3D"mailto:RC_WORLD@LISTSERV.IUPUI.EDU">Respiratory Care = Professionals=20 World Forum</A> ; <A title=3Dccm-l@list.pitt.edu=20 href=3D"mailto:ccm-l@list.pitt.edu">ccm-l@list.pitt.edu</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Sunday, March 03, 2002 = 7:58=20 AM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> (no subject)</DIV> <DIV><BR></DIV> <DIV><FONT face=3DArial size=3D2>How often are folks intubating with = double=20 lumen endotracheal tubes and for what indications? I don't meant = intra-op=20 for thoracic surgery...but pre-op...or post-op...for specific=20 injury/pathology and to facilitate independent lung ventilation.=20 </FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>For what injury/pathology are you = seeing this=20 performed most often? Example parenchymal injury/pathology or = bronchus=20 injury.....fistula etc. </FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>When your patient IS intubated in = this fashion=20 and each lung is being ventilated independently.....what kind of = strategy do=20 you employ regarding ventilator modes. Do you synchronize or not. Do = you=20 attempt to use just a little bit of CPAP with the injured side...or = some=20 other strategy. Do you conventionally ventilate the healthy lung and = "jet"=20 or "oscillate" the injured lung? Does tracheal gas = insufflation=20 have a role in this setting? Any thoughts?</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>keith</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Keith D. Lamb RCP, RRT</FONT></DIV> <DIV><FONT face=3DArial size=3D2>Charge Respiratory = Therapist<BR>Christiana Care=20 Hospital<BR>Newark,=20 Delaware</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML> ------=_NextPart_000_0057_01C1C2C1.51B0C320--
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