Category: Edcational

Covid Intubation; Stridor, Glottic Stenosis 

Covid Intubation; Stridor, Glottic Stenosis. Misleading Vital Oxygen Readers.

Do you have a loved one struggling after coming home after recovering from a severe case of Covid-19, was Intubated fighting for his/her life and you now notice unusual sounds coming from your loved one?

Perhaps it sounds like a bazaar humming sound or harmonic as time goes by. The noises are becoming longer durations and distressing for your loved one, yet vitals are stable, including O2 oxygen reader…? 

Then this topic may help you or your loved one. Vital O2 oxygen readers can be very misleading and rather confusing when it comes back within normal range, yet your loved one looks to be in distress, trying to breathe? This would include those especially with tracheostomy or post tracheostomy after Covid-19 recovery

What is Stridor Breathing…?

Bilateral vocal cord paralysis is a common cause of stridor in adults. It results from a disruption in nerve function in both of the vocal cords, the two small structures in the throat that vibrate and collide to produce sound, leading to vocal cord tissues blocking the airway. This causes biphasic stridor, which means the symptoms of noisy breathing occur when a person inhales and exhales.

Bilateral vocal cord paralysis can result from being intubated, having a breathing tube inserted. These procedures can cause scar tissue that interferes with breathing.

What is Glottic Stenosis…?

Glottic stenosis describes a fixed narrowing of the upper airway at the level of the glottis. The glottis is the portion of the larynx containing the vocal cords and the glottic opening. Anatomically, the glottis is the part of the larynx extending from the junction between the true and false vocal cords at the apex of the laryngeal ventricle to a line one centimeter below the inferior aspect of the vocal cords. The anterior two-thirds of the glottis is the glottis vocalis, while the posterior third is known as the respiratory glottis.

Acquired glottic stenosis is more common and has multiple factors. The most frequent is trauma secondary to endotracheal intubation, which is thought to occur due to the tube’s pressure effect causing tissue ischemia, inflammation and scarring. The risk of glottic stenosis is related to the duration of the intubation, the size of the endotracheal tube, the number of intubations, and excess movement of the endotracheal tube in agitated patients. Also, prolonged nasogastric intubation causes mucosal ulceration which may progress to posterior stenosis.

Post endotracheal intubation stenosis is the most common type of glottic stenosis.  The risk of developing stenosis in intubated patients has been found to be higher based on two prospective studies realized in the long term intubated patients, particularly in those intubated for five days or longer.

Acquired glottic stenosis thought to be caused by mucosal ulceration which leads to infection, perichondritis, and cartilage necrosis leading to granulation tissue formation over the vocal process of the arytenoid cartilage. Subsequently, scar formation and fibrosis cause contraction and arytenoid fixation.

The clinical presentation of glottic stenosis is variable and depends on the cause and the severity of the stenosis. The most common presentation of laryngeal obstruction is stridor. The level of the airway obstruction determines the nature of the abnormal breathing sounds. Upper airway obstruction results in mostly inspiratory stridor while obstruction in the lower respiratory tract results in expiratory or biphasic stridor.

Acquired glottic stenosis symptoms depend on the severity and location of the stenosis. Respiratory symptoms are the predominant symptoms in posterior glottic stenosis while anterior glottic webs mainly present dysphonia. In general, patients may present with respiratory distress. Other symptoms include hoarseness, alteration of voice, and aphonia. Dysphagia and aspiration may also be present.

History needs to concentrate on the assessment of dyspnoea and stridor, the onset and severity of the symptoms as well as the aggravating and relieving factors. Also, the voice should be thoroughly assessed. Finally, history should focus on previous episodes of intubation, trauma, infectious and inflammatory processes as well as co-morbidities.

Lastly, when in doubt and you feel something alarming going on with your love one, keep on track getting the best care and don’t settle on an ER Band-Aid treatment. Keep going until you find answers.

This especially true to those who had intubation for extended period of time due to Covid-19, those with healing trach wounds from previous Tracheostomy and removed post Covid-19.

Marsha B

FeaturedForgiveness versus Acceptance; Catalyst of Unhealthy Guilt

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“Catalyst of Unhealthy Guilt”

It is often said that forgiveness is a healing process, healing within itself is for those who seek it. Forgiveness can be the ultimate sacrifice one does to alleviate pains of sorrow. A sorrow so deep at times it can feel unbearable until one can release this pain.

Then there is another kind of forgiveness that we sometimes seek that can drive a wedge between those we love. The “unhealthy guilt” , sometimes called “Irrational guilt”, where we mistakenly take on unhealthy guilt because the pain can feel horrendous. Pain that can be misplaced where one can only assume this to be true if we didn’t recognize the difference.

[In other terms this can be best described as “Irrational guilt” that leads to “doubts about oneself” and “irrational shame” that is displaced. Hallmark features for Anxiety and OCD.]

The catalyst of unhealthy guilt; the straw that broke the camel’s back…

Before we go further one must ask themselves,

· Why am I seeking forgiveness?
· What do I wish to gain when asking for forgiveness?
· What action do I wish to receive from someone else in return?
· When does asking for forgiveness become too much?

The healing of our own emotions can only be done through first healing ourselves.

This is especially true if you have carried the burdens of unhealthy guilt. But many similar emotions we feel can lead to unhealthy guilt if one suffers from grief or loss, anxiety, depression, etc. But grieving a loss does not necessarily mean the death of a love one.

There are many factors in life where one may grieve and most often related to unresolved emotions steaming from circumstances beyond control.

Where we feel this lack of control in our lives may become the hindering compulsive action we seek externally. Like any reactions, unhealthy guilt can feed into the notion that what we are feeling or what we might be saying to ourselves must be true.

The catalyst of an unhealthy guilt can lead to years of chaos in our lives if we do not seek the underline source of our emotions.

Unhealthy guilt leads like an addiction and spreads like wildfire through the trees and plains that have become out of control.

Perhaps there were times one found themselves apologizing over-and-over asking for forgiveness believing past circumstances warranted this to be factual right down to the core of one’s conscience state of mind.

In many stages of unhealthy forgiveness or irrational thinking one may convinces themselves at times to being repetitive in nature to sorrows and notions within thought. Perhaps one may become consumed by the “what ifs” in thoughts of sorrows, unhealthy guilt and/or self-doubts.

This combo is like mixing magnesium sulfate and carbonated beverages. Sooner or later it will explode.

[Most importantly, sometimes thoughts serve no other purpose than to simply be thoughts.]

There comes a time in a person life that one may need to reexamine the situation and ask themselves “why is it that I feel so compelled to seek forgiveness?”

People generally don’t like to live in past tense and at times this pattern of behavior can hinder one’s ability to move forward into a healthier state of mind.

Is it possible for one to misinterpret such compelling words by repeating the same thing to such great overabundance?

Absolutely, this can happen for several different reasons. Communication can drive a wedge when we misunderstand our own thoughts process. At times repeating actions or obsessively thinking, ruminating or having pressurized thinking to reassure patterns of behavior.

Obsessive or irrational thoughts/actions can drive a person away like salt on open wounds; the instability of irrational guilt’s, leaving feelings of hopeless about situations.

This kind of repetitive behavior often creates problems by stirring up emotions that may carry very little value because why else would we ruminate such things that make us miserable.

However just like an addiction, unhealthy guilt can become an unhealthy behavior. There have been many discoveries through science and psychology where proven the pathways to our brains can change when we change our actions. This is especially true to changing behaviors. Like any addiction or habit the changes start within.

As many addictions and mental health situations, they are not always circumstantial, nor do them fade without changes we make within ourselves but rather things may become much more manageable as time passes.

But only through time can we see these changes as they accrue.

Most often great changes can take years to accomplish as we begin recognize what it is we are trying to change. The same is true for unhealthy guilt.

You cannot make up for lost time, nor can a person change what has already been done. The only thing we have in our lives where we can maintain control are our own emotions, thoughts and our own actions. Healthier choices will lead us down a path of willingness to maintain control of our destiny.

It’s those choices we make now, currently in plain view that where we may come to embrace our future. Like any kind of addiction, unhealthy guilt comes with emotional pain; where there is uncertainty there is fear and fear can be a powerful motivator.

Time doesn’t stand still for anyone and neither should you. When we learn to let go unhealthy, irrational guilt, the chain may become undone and one may no longer be hindered by the inability to move forward but rather we gain insight.

Marsha Beede