Deviation in the Standard of Anesthetic Care Resulting in Tracheal Injury

Evaluate breaches in the standard of care when evaluating Deviation in the Standard of Anesthetic Care Resulting in Tracheal Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a detailed medical history obtained?
    Yes
    No
    Answer unknown
    Why is this important?
    A thorough medical history is essential to recognize any potential challenges. Identification of previous difficult intubations and of any past/current illnesses that could compromise the integrity and anatomy of the upper airway, the jaw, and the neck is paramount.
    (2012) 30 EMDCNA 2 401-420

  • Was a physical examination performed? Why is this important?
    Answer this question
    It is paramount to identify any anatomical abnormality that would be unfavorable for ventilation and intubation.
    (2012) 30 EMDCNA 2 401-420

  • Was an airway examination performed? Why is this important?
    Answer this question
    The airway examination includes an examination of the mouth opening, an assessment for restricted neck extension, presence of dentures or loose teeth and a Mallampati scoring evaluation to predict difficult intubation.
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  • Was the intubation for patients with risk factors conducted with extreme caution? Why is this important?
    Answer this question
    Patients presenting with risk factors need to be treated with adequate care to prevent tracheal injury.
    (2004) 22 EAMJEM 4 289-293

  • Were multiple attempts made at intubation? Why is this important?
    Answer this question
    Multiple attempts made at intubation may result in tracheal injury.
    (2004) 22 EAMJEM 4 289-293

  • Was the technique used for intubation appropriate? Why is this important?
    Answer this question
    Inappropriate techniques used for intubation may lead to tracheal injury.
    (2004) 22 EAMJEM 4 289-293

  • Was the size of the tube used appropriate for the patient? Why is this important?
    Answer this question
    The site of mechanical injury to the upper and lower airways depends upon the type of artificial airway, its size, and the size relative to the patient's anatomy.
    (2003) 24 ECLCMD 3 445-455

  • Was the depth of insertion of the tube appropriate? Why is this important?
    Answer this question
    The appropriate insertion depth for orotracheal tubes is 21 cm for females and 23 cm for males (measured at the corner of the mouth).
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  • Was a high endotracheal tube (ETT) cuff pressure maintained? Why is this important?
    Answer this question
    Cuff pressure must be maintained above 18 mmHg to prevent an air leak (air escaping around the ETT cuff) and reduce aspiration around the cuff.
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  • Which of the following symptoms did the patient develop after intubation? (Choose all that apply) Why is this important?
    Answer this question
    Signs of intubation related tracheal rupture are subcutaneous emphysema (rice krispies under the skin), shortness of breath, tachycardia, cyanosis and respiratory distress. These symptoms appear shortly after intubation.
    (2004) 22 EAMJEM 4 289-293

  • Were imaging studies performed to confirm the tracheal injury? Why is this important?
    Answer this question
    Early radiographic signs of tracheal injury include; (1) orientation of the distal portion of the endotracheal tube to the right with an over distended endotracheal balloon cuff, (2) migration of the balloon toward the endotracheal tube tip, (3) pneumo-mediastinum, and (4) subcutaneous emphysema. Bronchoscopy usually establishes the definite diagnosis.
    (2004) 22 EAMJEM 4 289-293

  • Which of the following complications did the patient develop? (Choose all that apply) Why is this important?
    Answer this question
    Intubation is reported to be the major cause of iatrogenic injury of the trachea.
    (2008) 102 EREMED 8 1208-1212