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Old 01-07-2013
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Default clinical question for you all as a challenge

a patient admitted with pneumonia has been cured, 8 weeks later unable to cough up mucus, what is the next step in management by you with this 88 year old patient in who you performed a tracheotomy 6 weeks ago?
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Old 01-07-2013
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I think, some measures has to continue at once to treat him, however as you said the first step then it should be IV steroids along with manual airway clearance which include percussion, shaking and vibration. Later on he should be treated with bronchodilator,mucolytic agents. Actually case didn't describe his current vitals. If he is stable then better to go for chest x-ray so that can determine whether obstruction is proximal or distal.
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Old 01-07-2013
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Diagnosis: Subglottic Stenosis



Workup: Neck AP/Lat X ray
CxR >>>>>MRI

Other
  • Videostrobolaryngoscopy
  • Flexible fiberoptic broncoscopy


T/T: Rigid Broncoscopy for dilatation>>>>>>surgical resection and end to end anastomosis
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Last edited by Novobiocin; 01-07-2013 at 03:30 PM.
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Old 01-07-2013
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thanks for your reply! chest xray is clear, heart rate is 88, blood pressure is 110/49, Po2 is 98%. Spontaneous capping trials are on and patient tolerates 7 days with cap. Modified Barium Swallow failed by the patient and at risk for aspiration. Is decannulation possible in this patient, and when?
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