SURGICAL MANAGEMENT

VENTILATOR SUPPRT

 All patients with ARDS will require extra oxygen. Oxygen alone is usually not enough,
and high levels of oxygen can also injure the lung. A ventilator is a machine used to open
airspaces that have shut down and help with the work of breathing. The ventilator is
connected to the patient through a mask on the face or a tube inserted into the windpipe.

a. Tracheostomy
-  is an opening (made by an incision) through the neck into the trachea (windpipe).

Before you do anything, assess the following for your patient:

 Respiratory status (ease of breathing, rate, rhythm, depth, lung sounds, and oxygen
saturation level)
 Pulse rate
 Secretions from the tracheostomy site (i.e. character and amount)
 Presence of drainage on tracheostomy dressing or ties
 Appearance of incision (i.e. redness, swelling, weeping discharge, or odor)

Steps:

Your surgeon will make a cut into your neck just below your Adam’s apple. The cut will go
through the cartilaginous rings of the outer wall of your trachea, also known as your windpipe.
The hole is then opened wide enough to fit a tracheostomy tube inside. And then the doctor may
hook up the tube to a ventilator, in case you need a machine to breathe for you. The tube will be
secured in place with a band that goes around your neck. This helps keep the tube in place while
the skin around it heals. 
 B. ENDOTRACHEAL INTUBATION

- is the process of inserting a tube through the patient’s mouth and into their airway. 

Intubation Steps
1. Before intubation, the patient is usually sedated or not conscious, allowing their mouth
and airway to relax. They often lie on their back, while the healthcare professional stands
near the top of the bed, facing the patient’s feet.
2. The patient’s mouth is gently opened. Using an instrument to flatten the tongue and
illuminate the throat, the tube is steered into the throat and advanced into the airway.
3. A small balloon around the tube is inflated to keep the tube in place and prevent air
from escaping. Once this balloon is inflated, the tube must be tied or taped in place at the
mouth.
4. Successful placement is checked by listening to the lungs with a stethoscope and can
be further verified through a chest X-ray.
 If faced with a problematic airway, call for the difficult airway cart and ask
experienced colleagues to help.
 Note: Preoxygenation and monitoring during awake intubation is important.