I'm gonna trick y'all something to get the care pit and then this is for suctioning when you have that gloves I always bring extra gloves just in case that way you already have them and you're sailing and you're Brock site you need a pen might and a stethoscope okay so Oh in your trick ties you wanna make sure the beds at a working level you want to come in do your whipper wash your hands introduce yourself to your patient ask them their name date of birth check for allergies and just and tell them what you're gonna do so the first thing we're going to do is we're going to suction your patient so you're going to tell them that you're gonna suction them that you hear a little bit of wetness whatever however you want to tell them so you want to make sure that they're owed to is hooked up you want to make sure that your section is on and what does it suction have to be on 180 to 120 so you want to make sure that's on which this doesn't work it's just mimics it so you just look to make sure that it's that 80 to 120 mmm why don't you want it any higher because it can damage them you coast up it can irritate it even more it can tear it so you want to make sure that you have it 80 to 120 this little gadget here helps the suction catheter stick in there and you want to make sure that you have everything out of the way you can use the bedside table for some of your stuff for the suctioning part your you just need your saline and the care kit and they're all over there and there's extra gloves over there so the first thing I'm going to do is tell the patient so no suctioning for suction you know I'm going to listen to your lungs you need to make sure that you listen to all areas of the of the anterior you do not have to pick up the mannequin in order to listen to the back we don't do that that's because the mannequins are way too heavy I don't care which side you start out on but you just want to listen I don't care which system you go if you go up down across whatever but just make sure that you compare each side and listen with each breath so you should do in the front about three so it's just going across okay I think the book shows where you start one way go across come over I don't care which way you do it you do have to remember on your left side you're going to listen in two areas so you'll listen just below the axilla and then just below the nipple line on the right side you want to make sure that you listen in three areas on the side so you'll listen right the axilla right about nipple line and then on down I'm not going to count off for you as long as you listen so you can tell your patient I hear that you have a little bit of wrong guy in there so we're just going to go ahead and get you suctioned does it matter which if this patient you're going down the Nerys something you want to make sure you look we're going to go down there trach but just a little FYI because it has been on test before you want to make sure that you look in their Nerys you want to make sure that you look in their mouth to make sure there's in there okay that would be obstructing if you're gonna go down in the fact and you gonna get set up only you want to make sure that you look at this there should be it's normal saline simulation there should be a date on it you and make sure it was the real thing that had the right you had the right solution and a date and it's not expired you also want to make sure this bottle that you're using is not the first time if it's been used before you want to lip it and make sure that you say that you're gonna lip it with this you flip it over this is the box that you want this box you want to make sure that you don't stick your fingers in there because this plastic goes in there to hold the Saline so we want to keep it sterile underneath it's just a box like so you can pop it and it'll stay you're gonna make sure that you do everything before you get your gloves on you also want to tell your patient to take some nice deep breaths before see hyperventilating get your table where you want it and if you don't know you once you get your sterile gloves on and you got your table away from there and you're like how am I gonna get that you can use your feet to pull this up okay my suction ready first clothes you know you can only touch the cuff once you get it on it doesn't have to be all the way down don't mess with it because that's where you'll end up and make it that sterile second one get your fingers underneath of it and you can slide your hands in make sure to keep that thumb up because that's another thing people will bring it across and then you think we didn't see it but guess what we did and we're standing there waiting for you to say I think I contaminated myself and it's okay don't think if you contaminate yourself you're done because if you catch it before you do anything that could harm the patient change your gloves if you want to bring three pairs of gloves over here to do it that's fine we just want you to know that you have to keep it sterile the next thing is you're going to try to get this out I like to pull mine out on my paper our own clothes so you have to decide now which hand is going to end up and be your dirty hand hmm right so now it's dirty okay now make sure that your right hand doesn't go up onto the clear part once it does then you contaminated a okay so you can take your pinky finger bring it off they've already hyper hyper oxygenated themselves you want to stick this in and test it to make sure that it's working then you're going to tell your patient what you're doing you're going to go in until they cough and then you're going to twirl it pump the suction you're not going to hold it on and bring it out and put the oxygen back on give them a couple minutes to recover you can tell them to take a couple deep breaths and then you're going to do it again you're going to do this three times I'm going to put the oxygen back on clear out your tubing third time and your job then what you can do so you be very section beam so I like to listen after I've sectioned them so I would listen again to his lung sounds the same thing back and forth with each breath and on the sides and just let the patient know you sound much better now you sound clear throughout your lung and that's done so that's one CPD the other CPE would be the cleaning if I get any questions yet so remember you're only going to do one or the other so with this one you're going to need your your trailer kit your gloves like I said I always bring extra gloves peroxide and your saline same thing with these you're going to make sure that they're the right solution and that they're not expired okay so you need to tell your patient now it's time for us to do your trade care I'm just gonna get my stuff ready so again if this is not new stuff you would flip it this you want to be a shiny side down I'm gonna take all my stuff out and set it how I want oh you don't do that now contaminated myself so therefore my question is and you can do that picked it down purpose if you use the gloves that are in there that aren't so great set your stuff up when you get ready to do it you can use another set of sterile gloves okay that's perfectly fine don't want in them is about that let's say no that so we're just going to tell the patient that we're going to start cleaning that over there for him so I'm going to put this in my half in half and I don't like to dump this meet this solution back into my container so I don't think the trash rinse then I'm gonna take my brush then I'm going to then you're gonna take your cute ear pipe cleaner and you're gonna dry the inside out I don't have to dry the outside a real person if you turn the tube sideways it should slide right in and it'll follow the path now your procedure is just a clean technique okay that was all the sterile so the first thing I'm going to do is I'm going to that and then I'm going to clean clean up under the tree top and bottom then I'm going to rinse it and then I'm going to dry it you want to make sure that it's all dry up under there so that you don't have any breakdown the next thing I'm going to do is I am going to clean the flange and make sure you know those can get all nasty I'm gonna kind of rinse it and then dry that also the next thing is I'm going to put my trick try on I like to do this before it but the the last Clause under there the key to this is and this wolf is something that would fail you you can do it however you want but if you take off one side of this trait tie one hand has to stay holding that you can't let go in order to fix something over here because that patient cook off as soon as you move your hand and toss that trait right out so and but it's whatever you're used to that's what I want you to do as long as if you unhook one side one hand has to stay there and then you only have one hand to use okay I like to go up under and under the old one and I will put the new one in you can always readjust it once you have it in place and you've gotten the old one off and now you're gonna get kind of get up and personal with the patient but I like to be safe when I have to be putting any trach back in it's not fun make sure move the old one and gently pull it when you remove the old one if you put the the little bell / thing down it makes it easier to pull through you want to gently pull it through then you can see you should have two fingers that fit up underneath of there nicely and you're going to put your gods I always tell students I like the guys to go from under and come up because if you don't know or you don't pay attention to which way it is and you grab it and you're not so gentle and pull it and it's set the wrong way it can move the trach around and then cause some discomfort to your patient so you have your patient done you clean up your mess put your patient at a comfortable height make sure you go over the bed make sure you put the air back on ask them if there's anything they need give them the call light and you're done any questions that's it so you either do one or the other okay if there's stuff