single lung ventilation

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To add to Mark's list of good suggestions, the Arndt bronchial blocker
is magic, especially when you already have a tracheostomy in. It can be
positioned perfectly with a bronchoscope and avoids the need to pull out
the trachy and insert a double lumen tube from above.
Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> rfsmithmd at comcast.net 2/08/2006 9:42am >>>
Not my idea, but the young and beautiful Dr. Roberts. 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of MARK FORREST
Sent: Tuesday, August 01, 2006 1:45 PM
To: Trauma & Critical Care mailing list
Subject: Re: single lung ventilation

Nice idea Rob,
This is one that I haven't seen, although working in a centre that
does
Major Head & Neck, Thoracic, trauma and teaches percutaneous
tracheostomy to
junior docs, you get to see most of the difficult complications in the
trachea. As a result we have used several 'novel' methods, where tube
change
has not been ideal or for tracheal injuries and differential lung
problems.
These include:
 
-Use of an uncut microlaryngoscopy tube (MLT), passed alongside the
standard
COETT to isiolate the lung -Use of two MLT tubes, passed beyond the
damaged
trachea
- Two MLTs (as above) with one lung on coventional ventilation and the
other
on an oscillator (seen jet vent used in similar fashion before)
- use of new generation of endobronchial blockers through the tube in
the
set or through a standard tube already in place
 
Just a few ideas to add to those 'back of the mind solutions' when
things
get difficult in ICU or resus room!!
Cheers
Mark F
UK
 
 


----- Original Message ----
From: Robert Smith <rfsmithmd at comcast.net>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, 1 August, 2006 5:15:44 PM
Subject: RE: single lung ventilation


Recently there was a pt. with a transmediastinal GSW. The esophagus
was
injured, repaired and developed a leak so the pt. developed
mediastinitis
and was quite ill. When his ET tube became dislodged he almost died.
The
left lung was full of blood and crap and was not contributing in any
useful
way. It was determined that he would benefit from R lung ventilation
but
everyone was scared to change the tube after his recent near death
experience. So Rocky had a resident attach a large diameter tube to
the
first one, and advance the whole thing into the R bronchus. It worked
great.
I don't know if any of you have had a similar experience.

Rob Smith, M.D.

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