Which of the following is recommended when administering aerosols to mechanically ventilated patients with a small-volume nebulizer?
a. Make sure the flow-by is turned on during administration.
b. Keep the HME in-line during the aerosol treatment.
c. Use the ventilator nebulizer system when appropriate.
d. Bypass the humidifier during the aerosol treatment.
ANS: C
Use the ventilator nebulizer system if it meets the SVN flow needs and cycles on inspiration. Flow-by should be turned off, because it produces a continuous flow through the circuit during exhalation while nebulization is proceeding. Remove the HME from the circuit, because it will trap the aerosol particles. Do not disconnect the humidifier.
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The patient was brought to the operating room and placed in supine position. After adequate general anesthesia was obtained, the left foot was scrubbed, prepped, and draped in the usual manner. No tourniquet was utilized. A skin incision was made along the lateral border of the fifth metatarsal and carried down to the subcutaneous tissue in line with the skin incision. Bleeders were clamped and
electrocoagulated. Dissection was carried down to the base of the fifth metatarsal where an osteotomy was made at the base. The bone was then delivered from the wound and sent to the pathology department. There was erosion of the head of the fifth metatarsal consistent with osteomyelitis. The toe was amputated and the entire specimen was sent to the pathology department. All of the tissues were débrided. The wound was irrigated and hemostasis assured. The subcutaneous tissue was very loosely reapproximated utilizing 4-0 Vicryl suture. The skin was not closed and was allowed to drain. A sterile dressing was applied to the wound. The patient was then transferred to the recovery room in satisfactory condition. Preoperative Diagnosis: Osteomyelitis, fifth metatarsal, left Postoperative Diagnosis: Same Procedure: Amputation of toe a. 28805–T4 b. 28810–LT c. 28810–T4 d. 28820–LT
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