Category: Pandemic

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

When the beast comes at night; Covid-19

At times coronavirus Covid-19 can be at it’s worst at night, well into the early mornings. This would be why this coronavirus Covid-19 has earned it’s title “The Beast”.

With much uncertainty at times trying to figure out if it’s possible to know if you’d had the coronavirus prior to vaccine being available as medical professionals lingered with identifying telltale signs and symptoms; often diagnosing patients labeled as an “indicator”. Yet it’s too soon for any of us to let our guards down as the coronavirus Covid-19 has the ability to mutate into different variants. I know I had my share of doubts because this can be very confusing for many, including myself. We hear and see the stories of shear horrors of families suffering in dominoes effective; one after another. Then comes along others that test positive without knowingly carrying variants of Covid-19.

Perhaps I may have lost sight of this beast that reeks havoc because when it hits home, your loved ones, this beast Covid-19 can tranquilized fear and begin to spiral like a vortex leaving heavily guarded hearts in much distress. This virus Covid-19 doesn’t discriminate, rather it exploits and devior human souls. As it did, leaving my loved on fighting for her life on a ventilator. I saw this beast Covid-19 as it came barreling down on more loved one and ravaged in ways I hadn’t seen. I assure this beast leaves wounded scares on those untouched.

As doctors and scientists race to discover, learn as time surpasses there’s still much uncertainty. I would say health-care workers, the essential workers on the forefront reinforce the hardest task at hand caring for our love ones through recovery and sometimes to the end. I give much gratitude to all for having strength where many of us couldn’t fathom the amount of courage, dedication, integrity within; what it takes to save lives by multitude.

It baffled many healthcare works and scientists where two topics came from trials of saving many lives. Blood clotting factors and oxygen levels as some healthcare professionals spoke with patients who would go see doctors, be able to respond in complete sentences without having catch their breath.

The irony came when patients would get vitals done their oxygen  levels were low and yet a person could speak freely without in some sort of hesitation. The monstrous beast, the coronavirus linked the ability to allow a person to inhale breaths but struggle to exhale carbon dioxide from a person’s lungs which resulted in lower oxygen levels.

The virus Covid-19, given testimonials by people who have survived “the beast that comes out at night while a person rest may do more harm and ravage chaos by early morning”.

Having a oxygen/carbon dioxide reader may save lives and get your love ones to a hospital or urgent care before this coronavirus, Covid-19 reeks havoc in silence.

When the beast comes at night; Covid-19

At times coronavirus Covid-19 can be at it’s worst at night, well into the early mornings. This would be why this coronavirus has earned it’s title “The Beast”.

As doctors and scientists race to discover, learn as time surpasses there’s still much uncertainty. I would say health-care workers, the essential workers on the forefront reinforce the hardest task at hand caring for our love ones through recovery and sometimes to the end. I give much gratitude to all for having strength where many of us couldn’t fathom the amount of courage, dedication, integrity within; what it takes to save lives by multitude.

It baffled many healthcare works and scientists where two topics came from trials of saving many lives. Blood clotting factors and oxygen levels as some healthcare professionals spoke with patients who would go see doctors, be able to respond in complete sentences without having catch their breath.

The irony came when patients would get vitals done their oxygen  levels were low and yet a person could speak freely without in some sort of hesitation. The monstrous beast, the coronavirus linked the ability to allow a person to inhale breaths but struggle to exhale carbon dioxide from a person’s lungs which resulted in lower oxygen levels.

The virus Covid-19, given testimonials by people who have survived “the beast that comes out at night while a person rest may do more harm and ravage chaos by early morning”.

Having a oxygen/carbon dioxide reader may save lives and get your love ones to a hospital or urgent care before this coronavirus, Covid-19 reeks havoc in silence.

Weathering the storm essentially; pandemic

My heart weighs heavily for those essentially working during the current pandemic. The future leads to a unpredictable crisis that appears to be never-ending and without certainty.

Covid-19 as we currently know doesn’t discriminate, regardless if one is healthy.

However with new discoveries and hypothesis through science we can begin to see the slight inclinations in current literature.

Written hypothesis in Chromosome and DNA leading to severity of cases in Covid-19 through Legendary Neanderthal in science.

Whereas science in Hematology clotting factor presume in hypothesis to Covid-19 may lead and/or add to clotting factors in conjunction that may or may not coexist. However not enough to suggest medications to reduce clotting by utilizing blood thinners.

Cardiology/Cardiovascular suggest possible permanent damage for some, as well, Pulmonary scaring.

Neurologist suggest hypothesis to neurological changes as a pivotal downward spiral for some but not enough to suggest to to be anything more than a hypothesis in duration of this pandemic.

Whereas those being an essential worker in medical, law enforcement, paramedics, fire department, and the many brave men and women that place their life on the line everyday battling this pandemic are most certainly courageous at the least as many of us could never go against this beast.

Some of us essentially working in non-emergency employed elsewhere have questions that may never truly be answered. As I question to myself ‘is it possible that many of us had Covid-19 prior to acknowledgement from federal government?” Testing wasn’t available for many essential workers and were simply told when ill to be labeled “indicators of possible Covid-19” and to quarantine.

With that being said the question remains how effective is contact tracing?

There’s no certainty in antibodies test or Covid-19 test with or without PCR due to false nagetives/positives or as some implied that those who passed away during pandemic that love ones were witten on death certificates conditioned to result of Covid-19, without Covid-19 testing at times.

However as an essential worker following guidelines many of us still wear mask, wash our hands frequently, sanitize and practice social distancing without certainty of already possibly been pre-exposed before acknowledgement from government.

Why…?

Because it’s the right thing to do even when others approach us without wearing a mask or practice social distancing.

I’m simply grateful to be alive and well.

[Video made previously before pandemic]

MB