A patient with a tracheostomy tube is receiving positive-pressure ...

[nramada]

A patient with a tracheostomy tube is receiving positive-pressure ventilation through a volume ventilator.
 
  Over the past 5 min, the peak inspiratory pressure has risen, and the pressure limit alarm is now sounding. On quick examination, you notice a generalized decreased in breath sounds. Which of the following problems is most likely?
  a. Partial obstruction of the tracheostomy tube
  b. Complete obstruction of the tracheostomy tube
  c. Development of a left-sided pneumotho-rax
  d. Obstruction of the left bronchus by a mu-cus plug

Question 2

A patient with a tracheal airway exhibits signs of tube obstruction. Which of the following are possible causes of this obstruction?
 
  1. The tube cuff has herniated over the tip of the tube.
  2. The tube is obstructed by a mucus plug or secretions.
  3. The tube is kinked, or the patient is biting the tube.
  4. The tube orifice is impinging on the tracheal wall.
  a. 2 and 4 only
  b. 3 and 4 only
  c. 1, 2, and 3 only
  d. 1, 2, 3, and 4

[ecabral0]

Answer to Question 1

ANS: A
A spontaneously breathing patient with partial airway obstruction will exhibit decreased breath sounds and decreased airflow through the tube. If the patient is receiving volume-controlled ven-tilation, peak inspiratory pressures will rise, often causing the high-pressure alarm to sound; dur-ing pressure-controlled ventilation, delivered tidal volumes will fall.

Answer to Question 2

ANS: D
Obstruction of the tube is one of the most common causes of airway emergencies. Tube obstruc-tion can be caused by (1) the kinking of the tube or the patient biting on the tube, (2) herniation of the cuff over the tube tip, (3) obstruction of the tube orifice against the tracheal wall, and (4) mucus plugging (Figure 36-36).