[DYSPHAGIA] re: patient post self-extubation

[kgoertz@pahd.sk.ca (Clarke-Goertz, Kim (PAHD))]

An update on my patient who self-extubated...
 
ENT saw her last week and determined UVF paresis.  He did not give much info
in terms of prognosis.  They are searching for a primary CA site with her at
the moment, so I guess that is taking priority.  I will be meeting with the
patient and her husband to see what if any treatment they would like in
terms of voicing considering her CA diagnosis.  Swallow-wise, she remains
the same, so not much improvement there.  
 
I'll post again with any interesting anecdotes.
 
Thanks for listening,
Kim
 

Kim Clarke-Goertz CCC-SLP (C) 

 

-----Original Message-----
From: cathie austin [mailto:orchidluv@hotmail.com]
Sent: Thursday October 25, 2001 20:30
To: Clarke-Goertz, Kim (PAHD); Dysphagia List
Subject: Re: [DYSPHAGIA] re: patient post self-extubation


Hi all, 
 
I asked one of our trauma docs how long he would wait for ENT eval, post
extubation, if someone had the discussed symptoms, and he stated no longer
than one week. I've also had the experience of a surgeon taking a let's wait
and see stance, I think it really depends on the doc and the medical
problems involved. 
 
I'm glad your patient got the needed referral- keep in touch with the
results!
 
Sincerely,
 
Cathie Austin, SLP 
 

----- Original Message -----
From: Clarke-Goertz, Kim (PAHD)
Sent: Thursday, October 25, 2001 3:52 PM
To: 'Dysphagia listserv'
Subject: RE: [DYSPHAGIA] re: patient post self-extubation
 
re: my lady with the self-extubation and subsequent dysphagia and aphonia...

She was admitted over 3 weeks ago with newly diagnosed diabetes, severe
hypoglycemia and CHF (short of breath and weak prior to admission).  She was
ventilated for less than a week, self-extubated on Oct.5th (so, 3 weeks ago
approx).  They have been investigating a primary CA site b/c malignant cells
were found (they suspect liver or gut so far).  I was made aware of her by
OT just two days ago, who was seeing her for ADLs and told me of her lack of
voice.  I'm not sure how the doc missed the referral to ENT, but alas he
did.  I made it yesterday and hopefully he'll be seeing her today sometime.


Her dysphagia so far has been managed with positioning, but I notice she's
not taking in much at meals, leaving her at risk for maln/dehyd.  I'm not
sure if it's the CA that's affecting appetite or the dysphagia or a
combination of both.

Hopefully once the ENT sees her, we'll have a better picture.

Thanks again for all postings.  BTW, I compared the recovery/resolution
times some of you emailed me and they ranged from 1-3 days to 1-2 weeks; so,
quite a range out there.  Unfortunately my patient is already 3 weeks post,
so no likelihood of spontaneous recovery for her.

I will post after ENT sees her for all who are interested.

Kim


Kim Clarke-Goertz CCC-SLP (C)



-----Original Message-----
From: LSterling@aol.com [mailto:LSterling@aol.com]
Sent: Wednesday October 24, 2001 18:11
To: kgoertz@pahd.sk.ca
Subject: Re: [DYSPHAGIA] re: patient post self-extubation


Hi Kim,
I would get ENT involved.  Even my self extubators have a voice in a day or
two unless there is significant edema.  You didn't mention what type of
surgery this lady had...a lot of CT surgeries have left recurrent laryngeal
nerve involvement because that branch is buried deep within the viscera.
She may have a paralyzed cord.
Laurie

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