Maya Angelou Poems

"Phenomenal Woman"


Pretty woman wonder where my secret lies.
I'm not cute or built to fit a fashion model's size
But when I start to tell them,
They think I'm telling lies.
I say,
It's in the reach of my arms
The span of my hips
The stride of my step,
The curl of my lips.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

I walk into a room
Just as cool as you please,
And to a man,
The fellows stand or
Fall down on their knees.
They swarm around me,
A hive of honey bees.
I say,
It's the fire in my eyes,
And the flash of my teeth,
The swing in my waist,
And the joy in my feet.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

Men themselves have wondered
What they see in me.
They try so much
But they can't touch
My inner mystery.
When I try to show them,
They say they still can't see.
I say,
It's the arch of my back
The sun in my smile,
The ride of my breasts,
The grace of my style.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

Now you understand
Just why my head's not bowed.
I don't shout or jump about
Or have to talk real loud.
When you see me passing,
I ought to make you proud
I say,
It's the click of my heals,
The bend of my hair,
The need for my care.
'Cause I'm a woman
Phenomenally.
Phenomenal woman,
That's me.


"Caged Bird"
A free bird leaps
on the back of the wind
and floats downstream
till the current ends
and dips his wing
in the orange sun rays
and dares to claim the sky.

But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his wings are clipped and
his feet are tied
so he opens his throat to sing.

The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hills
for the caged bird
sings of freedom.

The free bird thinks of another breeze
and the trade winds soft through singing trees
and the fat worms waiting on a dawn-bright lawn
and he names the sky his own.

But a caged bird stands on the grave of dreams
his shadow shouts on a nightmare scream
his wings are clipped and his feet are tied
so he opens his throat to sing.

The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.

"Son to Mother"
I start no
wars, raining poison
on cathedrals,
melting Stars of David
into golden faucets
to be lit by lamps
shaded by human skin.

I set no
store on the strange lands,
send no
missionaries beyond my
borders,
to plunder secrets
and barter souls.

They
say you took my manhood,
Momma.
Come sit on my lap
and tell me,
what do you want me to say
to them, just
before I annihilate
their ignorance?


"Africa"

Thus she had lain
sugercane sweet
deserts her hair
golden her feet
mountains her breasts
two Niles her tears.
Thus she has lain
Black through the years.

Over the white seas
rime white and cold
brigands ungentled
icicle bold
took her young daughters
sold her strong sons
churched her with Jesus
bled her with guns.
Thus she has lain.

Now she is rising
remember her pain
remember the losses
her screams loud and vain
remember her riches
her history slain
now she is striding
although she has lain.
"A Brave and Startling Truth"

We, this people on a small and lonely planet Traveling through causal space Past aloof stars, across the way of indifferent suns To a destination where all signs tell us It is possible and imperative that we discover A brave and startling truth And when we come to it To the day of peacemaking When we release our fingers From fists of hostility And allow the pure air to cool our palms When we come to it When the curtain falls on the minstrel show of hate And faces sooted with scorn are scrubbed clean When battlefields and coliseum No longer rake our unique and particular sons and daughters Up with the bruised and bloody grass To lie in identical plots in foreign lands When the rapacious storming of churches The screaming racket in the temples have ceased When the pennants are waving gaily When the banners of the world tremble Stoutly in the good, clean breeze When we come to it When we let the rifles fall from our shoulders And children dress their dolls in flags of truce When land mines of death have been removed And the aged may walk into evenings of peace When religious ritual is not perfumed By the incense of burning flesh And childhood dreams are not kicked awake By nightmares of abuse When we come to it Then we will confess that not the Pyramids With their stones set in mysterious perfection Not the Garden of Babylon Hanging as eternal beauty In our collective memory Not the Grand Canyon Kindled in delicious color By Western sunsets Not the Danube flowing in its blue soul into Europe Not the sacred peak of Mount Fuji Stretching to the rising sun Neither Father Amazon nor Mother Mississippi who, without favor, Nurture all creatures in the depths and on the shores These are not the only wonders of the world When we come to it We, this people, on this miniscule and kithless globe Who reach daily for the bomb, the blade, the dagger Yet who petition in the dark for tokens of peace We, this people on this mote of matter In whose mouths abide cantankerous words Which challenge our existence Yet out of those same mouths Can come songs of such exquisite sweetness That the heart falters in its labor And the body is quieted into awe We, this people, on this small and drifting planet Whose hands can strike with such abandon That in a twinkling, life is sapped from the living Yet those same hands can touch with such healing, irresistible tenderness That the haughty neck is happy to bow And the proud back is glad to bend Out of such chaos, of such contradiction We learn that we are neither devils or divines When we come to it We, this people, on this wayward, floating body Created on this earth, of this earth Have the power to fashion for this earth A climate where every man and every woman Can live freely without sanctimonious piety And without crippling fear When we come to it We must confess that we are the possible We are the miraculous, the true wonders of this world That is when, and only when We come to it.
On The Pulse of Morning by Maya Angelou
A Rock, A River, A Tree Hosts to species long since departed, Marked the mastodon. The dinosaur, who left dry tokens Of their sojourn here On our planet floor, Any broad alarm of their hastening doom Is lost in the gloom of dust and ages.
But today, the Rock cries out to us, clearly, forcefully, Come, you may stand upon my Back and face your distant destiny, But seek no haven in my shadow I will give you no hiding place down here.
You, created only a little lower than The angels, have crouched too long in The bruising darkness, Have lain too long Face down in ignorance Your mouths spilling words
Armed for slaughter. The Rock cries out to us today, you stand on me, But do not hide your face.
Across the wall of the world, A River sings a beautiful song, It says, come rest here by my side.
Each of you a bordered country, Delicate and strangely made proud, Yet thrusting perpetually under siege Your armed struggles for profit Have left collars of waste upon My shore, currents of debris upon my breast. Yet, today I call you to my riverside, If you will study war no more. Come, Clad in peace and I will sing the songs The Creator gave to me when I and the Tree and the Rock were one. Before cynicism was a bloody sear across your Brow and when you yet knew you still Knew nothing. The River sings and sings on.
There is a true yearning to respond to The singing River and the wise Rock. So say the Asian, the Hispanic, the Jew The African, the Native American, the Sioux, The Catholic, the Muslim, the French, the Greek The Irish, the Rabbi, the Priest, the Sheik, The Gay, the Straight, the Preacher, The privileged, the homeless, the Teacher. They all hear The speaking of the Tree.
They hear the first and last of every Tree Speak to humankind today. Come to me, here beside the River. Plant yourself beside me, here beside the River.
Each of you, descendant of some passed On traveler, has been paid for. You, who gave me my first name, you Pawnee, Apache, Seneca, you Cherokee Nation, who rested with me, then Forced on bloody feet, left me to the employment of Other seekers--desperate for gain, Starving for gold. You, the Turk, the Arab, the Swede, the German, the Eskimo, the Scot, You the Ashanti, the Yoruba, the Kru, bought Sold, stolen, arriving on a nightmare Praying for a dream. Here, root yourselves beside me. I am that Tree planted by the River, Which will not be moved I, the Rock, I the River, I the Tree I am yours--your Passages have been paid Lift up your faces, you have a piercing need For this bright morning dawning for you. History, despite its wrenching pain, Cannot be unlived, but if faced With courage, need not be lived again.
Lift up your eyes upon This day breaking for you. Give birth again To the dream.
Women, children, men, Take it into the palms of your hands. Mold it into the shape of your most Private need. Sculpt it into The image of your most public self. Lift up your hearts Each new hour holds new chances For new beginnings. Do not be wedded forever To fear, yoked eternally To brutishness.
The horizon leans forward, Offering you space to place new steps of change. Here, on the pulse of this fine day You may have the courage To look up and out and upon me, the Rock, the River, the Tree, your country. No less to Midas than the mendicant. No less to you now than the mastodon then.
Here on the pulse of this new day You may have the grace to look up and out And into your sister's eyes, and into Your brother's face, your country And say simply Very simply With hope Good morning.


"These yet to be the United States"


Tremors of your network
cause kings to disappear.
Your open mouth in anger
makes nations bow in fear.
Your bombs can change the seasons,
obliterate the spring.
What more do you long for?
Why are you suffering?
You control the human lives
in Rome and Timbuktu.
Lonely nomads wandering
owe Telstar to you.
Seas shift at your bidding
your mushrooms fill the sky
Why are you unhappy?
Why do your children cry?
They kneel alone in terror
with dread in every glance.
Their rights are threatened daily
by a grim inheritance.
You dwell in whitened castles
with deep and poisoned moats
and cannot hear the curses
which fill your children's throats.


"Alone"


Well I was lying, thinking, last night,
How to find my soul a home
Where water is not thirsty,
and bread loaf is not stone
Well, I came up with one thing,
and I don't believe that I'm wrong:

Alone, all alone,
Nobody can make it out here alone
Nobody can make it out here alone

Well, there are some millionaires
With money they can't use,
Their wives run around like banshees,
And their children, they're singing the blues
They've got expensive doctors
To cure they're hearts of stone,
But nobody, no nobody, can make it alone

Alone, all alone,
Nobody can make it out here alone
Nobody can make it out here alone

Now if you listen closely, I'll tell you what I know,
Storm clouds are gathering,the wind is gonna blow.
The race of man is suffering, and I can hear the moan,
But nobody, no nobody, can make it alone.

Alone, all alone,
Nobody can make it out here alone
Nobody can make it out here alone


"Still I Rise"


You may write me down in historyWith your bitter, twisted lies,You may trod me in the very dirtBut still, like dust, I'll rise.
Does my sassiness upset you?Why are you beset with gloom?'Cause I walk like I've got oil wellsPumping in my living room.
Just like moons and like suns,With the certainty of tides,Just like hopes springing high,Still I'll rise.
Did you want to see me broken?Bowed head and lowered eyes?Shoulders falling down like teardrops.Weakened by my soulful cries.
Does my haughtiness offend you?Don't you take it awful hard'Cause I laugh like I've got gold minesDiggin' in my own back yard.
You may shoot me with your words,You may cut me with your eyes,You may kill me with your hatefulness,But still, like air, I'll rise.
Does my sexiness upset you?Does it come as a surpriseThat I dance like I've got diamondsAt the meeting of my thighs?
Out of the huts of history's shameI riseUp from a past that's rooted in painI riseI'm a black ocean, leaping and wide,Welling and swelling I bear in the tide.Leaving behind nights of terror and fearI riseInto a daybreak that's wondrously clearI riseBringing the gifts that my ancestors gave,I am the dream and the hope of the slave.I riseI riseI rise.

"Men"


When I was young, I used to Watch behind the curtains As men walked up and down the street. Wino men, old men. Young men sharp as mustard. See them. Men are always Going somewhere. They knew I was there. Fifteen Years old and starving for them. Under my window, they would pauses, Their shoulders high like the Breasts of a young girl, Jacket tails slapping over Those behinds, Men.
One day they hold you in the Palms of their hands, gentle, as if you Were the last raw egg in the world. Then They tighten up. Just a little. The First squeeze is nice. A quick hug. Soft into your defenselessness. A little More. The hurt begins. Wrench out a Smile that slides around the fear. When the Air disappears, Your mind pops, exploding fiercely, briefly, Like the head of a kitchen match. Shattered. It is your juice That runs down their legs. Staining their shoes. When the earth rights itself again, And taste tries to return to the tongue, Your body has slammed shut. Forever. No keys exist.
Then the window draws full upon Your mind. There, just beyond The sway of curtains, men walk. Knowing something. Going someplace. But this time, I will simply Stand and watch.
Maybe.

"Remembrance"


Your hands easyweight, teasing the beeshived in my hair, your smile at theslope of my cheek. On the occasion, you pressabove me, glowing, spoutingreadiness, mystery rapesmy reason
When you have withdrawnyour self and the magic, whenonly the smell of yourlove lingers betweenmy breasts, then, onlythen, can I greedily consumeyour presence.

"A Conceit"


Give me your hand
Make room for meto lead and followyoubeyond this rage of poetry.
Let others havethe privacy oftouching wordsand love of lossof love.
For meGive me your hand.

"Touched by An Angel"


We, unaccustomed to courage exiles from delight live coiled in shells of loneliness until love leaves its high holy temple and comes into our sight to liberate us into life.
Love arrives and in its train come ecstasies old memories of pleasure ancient histories of pain. Yet if we are bold, love strikes away the chains of fear from our souls.
We are weaned from our timidity In the flush of love's light we dare be brave And suddenly we see that love costs all we are and will ever be. Yet it is only love which sets us free.

"Passing Time"


Your skin like dawnMine like musk
One paints the beginningof a certain end.
The other, the end of a sure beginning.

"When You Come"


When you come to me, unbidden,Beckoning meTo long-ago rooms,Where memories lie.
Offering me, as to a child, an attic,Gatherings of days too few.Baubles of stolen kisses.Trinkets of borrowed loves.Trunks of secret words,
I CRY.

"Million Man March Poem"


The night has been long,The wound has been deep,The pit has been dark,And the walls have been steep.
Under a dead blue sky on a distant beach,I was dragged by my braids just beyond your reach.Your hands were tied, your mouth was bound,You couldn't even call out my name.You were helpless and so was I,But unfortunately throughout historyYou've worn a badge of shame.
I say, the night has been long,The wound has been deep,The pit has been darkAnd the walls have been steep.
But today, voices of old spirit soundSpeak to us in words profound,Across the years, across the centuries,Across the oceans, and across the seas.They say, draw near to one another,Save your race.You have been paid for in a distant place,The old ones remind us that slavery's chainsHave paid for our freedom again and again.
The night has been long,The pit has been deep,The night has been dark,And the walls have been steep.
The hells we have lived through and live through still,Have sharpened our senses and toughened our will.The night has been long.This morning I look through your anguishRight down to your soul.I know that with each other we can make ourselves whole.I look through the posture and past your disguise,And see your love for family in your big brown eyes.
I say, clap hands and let's come together in this meeting ground,I say, clap hands and let's deal with each other with love,I say, clap hands and let us get from the low road of indifference,Clap hands, let us come together and reveal our hearts,Let us come together and revise our spirits,Let us come together and cleanse our souls,Clap hands, let's leave the preeningAnd stop impostering our own history.Clap hands, call the spirits back from the ledge,Clap hands, let us invite joy into our conversation,Courtesy into our bedrooms,Gentleness into our kitchen,Care into our nursery.
The ancestors remind us, despite the history of painWe are a going-on people who will rise again.
And still we rise.

"Refusal"


Beloved, In what other lives or landsHave I known your lipsYour HandsYour Laughter braveIrreverent.Those sweet excesses thatI do adore.What surety is thereThat we will meet again,On other worlds someFuture time undated.I defy my body's haste.Without the promiseOf one more sweet encounterI will not deign to die

"The Lesson"


I keep on dying again.Veins collapse, opening like the Small fists of sleepingChildren.Memory of old tombs,Rotting flesh and worms doNot convince me againstThe challenge. The yearsAnd cold defeat live deep inLines along my face.They dull my eyes, yetI keep on dying,Because I love to live.


THE BLACK FAMILY PLEDGE

BECAUSE we have forgotten our ancestors,our children no longer give us honor.
BECAUSE we have lost the path our ancestors clearedkneeling in perilous undergrowth,our children cannot find their way.
BECAUSE we have banished the God of our ancestors,our children cannot pray.
BECAUSE the old wails of our ancestors have faded beyond our hearing,our children cannot hear us crying.
BECAUSE we have abandoned our wisdom of mothering and fathering,our befuddled children give birth to childrenthey neither want nor understand.
BECAUSE we have forgotten how to love, the adversary is within ourgates, an holds us up to the mirror of the world shouting,"Regard the loveless"
Therefore we pledge to bind ourselves to one another, to embrace ourlowliest, to keep company with our loneliest, to educate our illiterate,to feed our starving, to clothe our ragged, to do all good things,knowing that we are more than keepers of our brothers and sisters.
We ARE our brothers and sisters.
IN HONOR of those who toiled and implored God with golden tongues,and in gratitude to the same God who brought us out of hopeless desolation, wemake this pledge.

Johari/Nohari Quadrants

diksyunaryo

Ilokano:
Antique - kabsat ni nanang
Decipher - saan nga dobotones
ravine - imneken jay init
begotten - panagimukat manen
who - panagkakantsaw
a one - wala
ham man - saanak nga agululbod
about - nauneg nga banag
stone - agsardeng kan
show - agbugaw manok

Modern English:
school - a place where papa pays and child plays
life insurance - a contract that keeps you poor all your life so that you can die rich
nurse - a person who wakes you up to give you sleeping pills
marrieage - it's an agreement in which a man loses his bachelor degree and a woman gains her masters
divorce - future tense of marriage
father - banker provided by nature
criminal - a person no different from the rest except he gets caught

Gay:
TERMS OF ENDEARMENT
“Girl!”, “Lolah!”, “Ateh!”, “Mamah!”, “Titah!”, “Sister!”, “Mother!”, “Bakla!”

PROPER NOUNS
Ace Sanchez - a top
Aglipay - ugly Pinay ( jowang pokpok na chaka ng mayaman na foreigner )
Ana, Anaconda - ahas, traidor
Anita Linda, Aida - A.I.D.S.
Ate Vangie - gamot pampatulog (Ativan Gang)
Ate Vi - atrebida
Backstreet Boys - cute guys sa likuran mo
Bayombong, Nueva Viscaya - masturbate
Bebang, Mayta - maid
Blusang Itim - mga bakla na gumanda nang maayusan sa parlor
Cathy Santillan, Kate Gomez, Cathy Mora, Cathy Dennis - makati, malibog
Chabelita - chubby
Chanda Romero - tummy (ang laki ng Chanda Romero nung pulis) / an old woman
Chiquito - maliit
Churchill - sosyal
Crayola Khomeni - iyak
Dakota Harrison P! laza - malaki tite
Debbie Gibson - give
Duty Free - maliit ang nota
Ella Mae (Saeson), Ella Fitzgerald, Ella Luansing - state of feeling horny
Eva Kalaw - evak
Felix Bakat - bakat ang tite (sa brief or pants)
Girlie Rodis - babae
Givenchy - give, pahingi
Halls - tsupa
Indiana Jones - hindi sumipot
Janjalani, Pocahontas - bakla na palaging late o indyanera
Jennilyn (Mercado) - cheap, chaka
Joana Paras - asawa
Julanis Morisette, Reyna Elena - umuulan
Julie Andrews - mahuli
Kelvinator, Kelvina - babaeng mataba, sinlaki ng refrigirator
Leticia Ramos Shahani - shabu
Lilet - bading na bagets
Lucita Soriano - loss na, sorry pa
Lucrecia Kasilag - baliw
Luz Clarita, Luz Clarita, Luz Valdez - talo, loss ang beauty
Maharlika, Mahalia Jackson - mahal
Manilyn Reynes - malibog
Miss Nigeria - negra
Murriah Carey, Morayta - mura
Nora Daza - magluto
Oprah Winfrey, O.P.M. - oh, promise me, pangako, utang
Phil Collins - Philcoa
Purita Kalaw Ledesma, Purita Kashiwara, Pureta Malaviga - poor, dukha
Rica Paralejo, Nina Ricci - mayaman
Rita Gomez - naiirita
Ruffa - laklak
Siete Pecados - tsismosa
Thunder Cats - gurang
Tom Jones, Tommy Lee Jones - gutom
Uranus - puwet
Washington D.C. - wala
X-Men - mga dating lalaki
Yayo Aguila - dyahe
Zsa Zsa Padilla - o siya, sige!

ADJECTIVES & ADVERBS
48 years - sobrang tagal
antibiotic - antipatika
balaj, valaj - balahura
bella - boba
bigalou - big
biway, chopopo, guash - gwapo
bongga, bonggakea - super to the max
borta - malaki katawan
boyband - lalaking sintaba ng baboy
buya - nakakahiya
chaka, chuckie, shonget, ma-kyonget, chapter, jupang-pang - ugly
cheapangga, chipipay - cheap, ka-cheapan
chipipay - cheap
chopopo - gwapo
conalei - baklush
daki - dako
dites - dito
doonek - doon
effem - halatang bakla
emena gushung - malanding semenarista
fayatollah kumenis - payat
ganda lang - for free
ganders - maganda
intonses - sira, wasak
jongoloids - bobo
jowa, jowabelles, jowabella - karelasyon, boyfriend o girlfriend
jutay, juts - maliit
kabog, loss - talo!
katagalugan - matagal
katol - mukhang katulong
kirara - pangit / maitim
klapeypey-klapeypey - pumalakpak
krang-krang - hungry (same as Tom Jones)
krung-krung - sira ulo, baliw
lulu, tungril, tetetet - lesbian
mahogany, mashumers, ugmas - mabaho
majubis - mataba / gusgusin
matod - magnanakaw
nakakalurky - nakaka-shock, nakaka-takot
neuro - napaisip bigla, mind-boggler
oblation - walang saplot
otoko - lalakeng lalaki
pamin, paminta, pamentos, pamenthol - discreet gay guy
pinkalou - pink
pranella - praning
quality control - maganda ang quality
sangkatuts - marami, isang katutak
shala - sosyal
shogal - matagal
shokot, bokot - takot
shonga, shongaers, planggana - tanga
shonga-shonga - tanga-tanga
shonget, makyonget - ugly
shontis - buntis
sudems - never
tamalis - tamad
urky - nakakaloka
warla - loka-loka, nawawala sa sarili, nababaliw
wasok - contraction ng “wasak pag pasok”
wiz, waz - wala!
wrangler, thunder(s), tanders, majonders – matanda

NOUNS, PRONOUNS AND PREPOSITIONS
adez, andabelz, adesa, anda, ka-andahan, andalucia - pera
akesh, akembang - ako
badet, dinga, dingalou - bading
berru - beer
borlog - tulog, power nap
bottomesa, bottones - a bottom
bufra - boyfriend
carrou, carosa - car
cheese - chismis
chimi, chimini, chimi-aa, chimini-aa - maid
constru - construction workerdaot - ahas, traitor
ditey, ditich, ditraks - dito
feelanga - crush
fiampey - singit, etits, flower
garapata - vaklush na punggok na majubis
gardini - security guardoishi - shabu
gulay, pechay, bilatch, tahong - babae
hada - oral gay sex
hammer - pakonyo effect sa mga prosti or callboy, “pokpok”
havana - mahabang mukha
hipon - maganda ang katawan pero panget
itich, itechlavu - ito
itich-me-how - etits, penis
jipamy - jeep
jowa, jowawis - lover, boy/girlfriend
jubelita - vaklita, batang bading
kat-kat - sosyal na tawag sa katulong
katol, chimay - katulong
kyota - bata
kyotatalet - sanggol
likil, mentos, future - lalaki
merlat, melat, bilat, mujer - babae
nota, notes - penis
pa-uring - a bottom
performance artist - mahilig mag-inarte
potato queen - chink for chinks
red alert - menstruation
rice queen - chink folks who go for white guys (?)
colbam, sholbam - callboy
shulupi - pulubi
shumod, shumodity - tamod
suba, bugarou - cigarette
success story - babae/lalaki na mukhang katulong na may lover na foreigner na masalapikaturay - baklang mukhang katulong na mataray
tayelz - tayo
variables - barya, coins
wigwam - wig

VERBS
bacstroke - bugbugin
bet, fillet - gusto
bionic, bayas, bayis - magjakol
bona, kimbash, uring - tirahin sa pwet
bongkang, shongkang, tsuplukan - kumantot
booking - to hook up with someone
borlog, tulogsi - matulog
dramamin - umaastang lalaki
entourage, enter the dragon - pumasok
getluck - kuhanin
gora, godelya - go
hada, koflang, kops - suck
jeverly, kalaw, erna - dudumi
krompal - sampal, but with an attitude (kasi may kasamang kuko)
lafez, lafang, lafour - kain
nomo-nomo, normok - inom
payola - pay
rampage - rampa
rendez-vous - takbo
shonggal - tanggal
sight - look
strungga - nenok, nakaw
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lou
pinkalou - pinkcarou - carchuvalou - common __expressionchiva-lou - hada or bjorangalou - anal sex from the rootword orangapagurlalou - pa-girlchufalou - hada
china
payolachina - paypangitchina - pangitchupachina - blow jobmukachina - face
ra/delya
pagodora, pagodelya - tiredbongadera, bongadelya - ang ganda mo day
grabedora, grabedelya - grabe
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one pokels - pisoone hammer - P 100one kiaw - P 1,000
P 1,553 - one kiaw, five hammer, at nyifti three pokels
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Spanish - Filipino GaylingoChorizo de Bilbao - penisGrande - malaki
Granada de Espa�a - grabe
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ANO ANG BAGONG TAW! AG SA JOWA IN THE NEW MILLENIUM?
It depends.
Pag one-time hada lang: STUDIO CONTESTANT.Pag more than once at frequent ang encounter: MONTHLY FINALIST.Pag nagkaka-develop-an na: GRAND FINALIST.Pag nagsasama na at ibina-bahay: LUCKY HOME PARTNER.Pag call-in callboy: LUCKY TEXT PARTNER lang.
*************************************************
Chorvah has its etymology from the Greek word cheorvamus meaning “for lack of the right word to say”, or “in place of anything you want to express but cannot verbalize”. Ibig sabihin pala, siya ay parang “aloha” sa wikang Hawaiiano, which can mean many, many things. “Chorvah” can be used as:
1. Noun: “ano” / “kwan” / “or something”
- “Ate Glow, kelan yung birthday chorvah ni Big Mike?”
- “Hoy, Vicky ‘to, whatcha gonna wear ba? The sporty or the chinese chorvah mo?
2. Adjective: used if you want to be polite.
- “Ang chorvah naman niyan!”
( So, ano ba? Pangit ba o maganda? Baduy ba or ang arte?)
They will never know what you really mean. How polite!
3. Verb: can replace any verb
- “Chorvah lang ng chorvah!”
Chorvah is such an amazing word, it lets you choose your own adventure. At least you will never be accused of putting words in somebody else’s mouth. If you don’t have anything to say, or you can’t find the right word to say, or you want to say something but you don’t know how to say it, just say CHORVAH!
Variations: Chuvah, Chenes, Chenelyn

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Wound Care

General considerations

The injury: The mechanism of injury is important in assessing the degree of risk of complications of a given wound. For example, the farmer who pierces his foot with a manure-laden pitchfork is at high risk for gas gangrene and sepsis. Management would include extensive local wound care and possible admission to hospital for intravenous antibiotics. Mammalian bites present another risk situation for infection. Is there likely to be a foreign body present in the wound? Does the force of injury suggest there is likely to be extensive trauma to deeper tissues?

The patient: Consider complicating medical conditions such as diabetes, other immunosuppressed states including diabetes or other major organ dysfunction (such as renal or hepatic failure) and peripheral vascular disease. These all may affect both resistance to infection and wound healing itself.

Time of injury: The age of the wound is important in deciding the timing of closure, if at all.

Laceration	Age / Condition	Treatment
Extremity	< 12 hours and “clean”	suture primarily
Extremity	>12 hours older or “dirty”	Older or obviously contaminated or infected lacerations are best left alone for healing by secondary intention or tertiary intention (closure a few days later). Saline soaks and antibiotics usually will be required. If cosmetic or other functional considerations apply, then referral to a plastic surgeon is necessary.
Face	< 24 hours	suture primarily unless obviously infected (rare)

These times are based on common medical practice in Canada. A study of forearm and hand lacerations found that closure within 4 hours had a lower infection rate than more than 6 hours from injury.¹

Consultation: Emergency physicians may consider early referral of certain lacerations to an appropriate surgeon. Indications for referral could include:

• Deep lacerations that involve nerve, tendon (often flexor tendon injuries of the fingers) or bone,
  
• Complex or extensive lacerations that may be challenging to repair or are located in difficult anatomical areas.

Assessment of function and the importance of wound exploration

Assess wounds under optimal lighting with minimal bleeding. Important structures underlying any laceration or contusion should be assumed divided until proven otherwise. Motor, sensory and vascular function must always be assessed.

The physician, however, cannot rely only on tests of motor or sensory function to rule out injuries to tendon or nerve. Only a small portion of a tendon in the finger, for example, needs to remain intact to maintain function. However, if the patient is sent home with such a partial tendon injury, total rupture may occur when the tendon is stressed.

Note that there is no reliable test for isolating a particular wrist flexor or extensor, because more than one muscle performs the same function.

Therefore, wounds in the vicinity of important structures should be gently explored. If visualisation is difficult or the anatomy complex, then an appropriate surgeon should be consulted.

Tendon, nerve or vascular injuries are all too easy to miss unless due care is taken.

Finger Injuries

Injuries to the fingers and hands account for the majority of such cases. Tendon and nerve injuries of the fingers will now be reviewed, followed by a brief discussion of vascular injuries.

Tendon, nerve or vascular injuries are all too easy to miss unless due care is taken. In addition for testing function, these wounds should be gently explored. Injuries to the fingers and hands account for the majority of such cases.

A tendon is visualized through the open wound margin of this wound of the hand.

Finger Injuries

Tendon and nerve injuries of the fingers will now be reviewed, followed by a brief discussion of vascular injuries.

1. Extensor Tendon Injuries of Fingers: The anatomy of the extensor aponeurosis is depicted in the diagram below. Extension is accomplished through the action of the extrinsic digital extensors, and the interosseous and lumbrical muscles.
   
   Transection or avulsion of the central extensor slip from the base of the middle phalanx may allow the lateral band to slip in a volar direction and assume a PIP flexor action. This produces the classical “boutonniere deformity”. The patient may initially exhibit a full range of motion, including extension.

2. Flexor tendon injuries of fingers: A missed flexor injury of the finger may result in long term disability. The anatomy is depicted in the accompanying diagram. The profundus runs the entire length of the finger and inserts into the distal phalanx. If intact, the finger can move normally, even if the superficialis is divided.
   
   

   Profundus tendon testing of long finger D3	Superficialis tendon testing of long finger D3

   
   The testing of these tendons – both the profundus and the superficialis is shown
   above. The test of the superfialis tendon can only be accomplished with all of the other digits being restrained in extension. Moreover, it is not reliable for the index finger. These tests do NOT replace exploration and visualization of the tendons in the wound.
   
   

3. Digital nerve injuries: The digital nerves exit the hand in the region of the volar web spaces, tracking along the medial or lateral aspects of the fingers.
   
   The digital nerves run immediately adjacent to the flexor tendons.
   
   Numbness or complete loss of feeling is not necessarily noted by the patient immediately even if there is complete transection of the nerve. A peculiar or unusual sensation in the territory of the nerve may be the only subjective description.
   
   If there is digital arterial bleeding, then the digital nerve is likely to be injured.
   
   Sensory testing is best done using two-point discrimination.
   
   If the history or physical findings suggest the possibility of a digital nerve injury, then exploration to visualise the digital nerve is necessary. A referral to a plastic surgeon is necessary. However, digital nerve injuries beyond the level of the DIP joint are not repaired and do not require referral.

4. Vascular Injuries
   Most arterial and venous injuries occur within the traumatised limbs. Early diagnosis is important.
   
   Consider the proximity of the wound to arterial structures. A history of bright red blood spurting from a wound indicates an arterial injury. Often, by the time of evaluation within the Emergency Department, this bleeding has stopped because of vasospasm (or uncommonly because of hypovolemic shock).
   
   The presence of a bruit or thrill frequently indicates a significant vascular lesion. Look for the classic six “P’s” in the distal extremity:
   

   pain
   pallor
   pulselessness
   paresthesia
   paresis
   poikilothermia

   Pulses may or may not be absent depending on the degree of injury.
   
   Venous injuries that are significant may be difficult to diagnose. These usually co-exist with arterial or nerve injuries. Arteriovenous fistula may occur.
   
   Compartment syndrome: Look out for
   1. Passive stretch pain of the muscles within the compartment
   2. Compartment swelling

The involved compartment needs to be released immediately.

Local anesthetics

There are two major groups of local anaesthetics: esters and amines.

1. Esters : procaine (Novocaine), and tetracaine (Pontocaine)
2. Amines: lidocaine (Xylocaine) and bupivacaine (Marcaine).

If a past allergy is reported, an anesthetic from another class can be used. Most often, however, the allergy is to the preservative used in the lidocaine multidose vials. Therefore, one option is to use a single-dose lidocaine preparation that does not contain preservatives.

For routine Emergency room use, a mixture of lidocaine 1%, with or without epinephrine 1/100,000 parts, is recommended. For regional nerve blocks, a 2% solution is used. The lidocaine 2% solution can be combined with equal parts of the Marcaine 0.25% solution to obtain relatively quick, yet longer lasting anaesthesia. The anaesthetic effect of lidocaine lasts less than an hour, but as long as two hours if the epinephrine containing preparation is used. Marcaine’s effect lasts from 12-24 hours. This would be important, for example, in the case of a distal digit amputation, where longer-term anaesthesia is desired. Some patients continue to experience considerable pain even after simple suturing, and Marcaine could significantly reduce such pain.

Epinephrine is commonly used as an adjuvant to reduce bleeding and slow anaesthetic absorption systemically. A noticeable decrease in wound bleeding will be noted in about seven minutes. Epinephrine should be avoided in those patients with vasospastic disorders, those with crush or circumferential extremity injuries, or those on beta-blockers. The use of epinephrine in the fingers, toes or penis has classically been contraindicated, because of its supposed propensity to cause vasospasm in these areas.

A toxic dose of Xylocaine (lidocaine) is 3 mg per kg intravenously; 5 mg per kg when injected without epinephrine into the wound margin, and 7 mg per kg when injected with epinephrine into the wound margin. There is evidence that the toxic dose may actually be much higher than usually quoted. The toxicity of Marcaine is one-quarter that of lidocaine, on a weight to weight basis.

Prior to the administration of local anaesthetics, check the sensory and motor nerve response, and for allergy (very rare). The pediatric literature supports the use of a topical anesthetic such as LET (a combination of lidocaine, epinephrine and tetracaine) prior to needle infiltration to reduce the pain. Slow injection by a small needle (such as a 25, 27 or 30 Gauge) will reduce the pain of infiltration.

Adverse reactions to local anaesthetics may take several forms.

Adverse Reactions to Local Anaesthetics
Type	Incidence	Mechanism	Symptoms
Vasovagal	Common		nausea, light-headedness bradycardia vasodilatation hypotension syncope
Epinephrine related	Common		“ rash” tremor, headache palpitations abdominal and uterine cramps
Toxic (>3mg /kg IV, >5 mg/kg without epinephrine, > 7 mg/kg with epinephrine)	relatively common	IV leak (? From regional blocks?)	tachycardia arrhythmia CNS excitation, depression seizure, coma
Allergic	rare to amides uncommon to esters	IgE mediated ? methylparaben preservative ? antioxidants (sulphites)	angioedema bronchospasm tachycardia hypotension

If there is doubt about allergy, in minor cases, plain normal saline can be injected into the wound margin to stretch the skin, thereby affording some degree of anaesthesia.

Malignant hyperthermia is now considered NOT to be precipitated by the use of lidocaine. Traditionally, in this setting, an ester has been utilised.

Tetanus prophylaxis - Tetanus vaccination
The tetanus disease itself is a serious one but relatively rare in Canada.

An identifiable acute injury occurs in the majority of cases (70%). Puncture wounds and lacerations account for most cases. Interestingly, approximately one-half of these injuries occurred indoors. Only a small percentage of cases occur in previously properly “immunised” patients. The incubation period is from two days to two months.

Tetanus vaccines must be administered intramuscularly. The anterolateral thigh is recommended in infants and the deltoid muscle in older children and adults. These adsorbed vaccines should not be administered subcutaneously as sterile abscess can form.

Since 1982, all school children in Ontario are required by law to be immunised. As of 1987, it is the law in Ontario that physicians inform their patients of the risks and benefits of immunisation. Adverse reactions to primary immunisation with tetanus toxoid are rare. The booster dose, however, can cause local erythema and swelling. Overuse of tetanus vaccines can lead to Arthus type reactions, urticarial reactions, and angioneurotic edema , and rarely, peripheral neuropathy and anaphylaxis.

Tetanus immune globulin (human) is a passive immunising agent containing preformed antibodies. Serum sickness can occasionally occur especially in the past when the globulin was derived from horse sera.

The decision to administer tetanus prophylaxis in the Emergency room depends on the current immunisation status of the patient and the liability of tetanus contamination in a given wound. In this Emergency Department, the order for a “tetanus booster” usually means that tetanus polio (Salk type) inactivated vaccine is administered.

Several protocols for the administration of tetanus prophylaxis are available.
The Canadian Immunization Guide – 6^th Edition – 2002 is available at

http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/cig-gci/.

Prophylactic oral, IM or IV antibiotics in wound care of routine lacerations
There is NO evidence (based on many clinical studies and a meta-analysis) to support the routine use of prophylactic oral, IM or IV antibiotics to prevent wound infections after closure of routine lacerations. Antibiotics do NOT substitute for proper wound cleansing.
Prophylactic antibiotic treatment is, however, proven to be of value in the treatment of animal and human bites in particular. See D. Special Situations in Wound Care / Mammalian bites
``Use of antibiotics should be individualized based on the degree of bacterial contamination, the presence of infection-potentiating factors, such as soil, the mechanism of injury, and the presence or absence of host predisposition to infection. In general, decontamination is far more important than antibiotics. Prophylactic antibiotics should be used in most human, dog, and cat bites, intraoral lacerations, open fractures, and exposed joints or tendons.`` From Management of lacerations in the emergency department. O. Capellan and J. Hollander Emergency Medicine Clinics of North America. Volume 21, Number 1, February 2003

Suctioning a Tracheostomy

Suctioning a Tracheostomy
The upper airway warms, cleans and moistens the air we breath. The trach tube bypasses these mechanisms, so that the air via the tube is cooler, dryer and not as clean. In response to these changes, the body produces more mucus. The trach tube is suctioned to remove mucus from the tube and trachea to allow for easier breathing. Generally, the child should be suctioned every 4 to 6 hours and as needed. There may be large amounts of mucus with a new tracheostomy. This is a normal reaction to an irritant (the tube) in the airway. The heavy secretions should decrease in a few weeks. While a child is in the hospital, suctioning is done using sterile technique, however a clean technique is usually sufficient for most children at home. If your child has frequent respiratory infections, trach care and suctioning techniques may need to be addressed. Frequency of suctioning will vary from child to child and will increase with respiratory tract infections. Try to avoid suctioning too frequently. The more you suction, the more secretions can be produced.

Care Techniques
Sterile Technique: sterile catheters and sterile gloves
Modified Sterile Technique: sterile catheters and clean gloves
Clean Technique: clean catheter and clean hands
The size of the suction catheter depends on the size of the tracheostomy tube. Size 6, 8 or 10 French are typical sizes for neonatal and pediatric trach tubes. The larger the number, the larger the diameter of the suction catheter. Use a catheter with an outer diameter that is about half the inner diameter of the artificial airway this will allow air to enter around it during suctioning. You can also compute the catheter size with this formula: Multiply the artificial airways diameter in millimeters by two. For example, 8 mm X 2 = 16, so a 16 French catheter. Also see Tracheostomy Sizing Chart for recommended catheter sizes for specific Bivona and Shiley pediatric tracheostomy tubes.
Older children may be taught to suction themselves.

Suction Depths
Shallow Suctioning: Suction secretions at the opening of the trach tube that the child has coughed up.
Pre-measured Suctioning: Suction the length of the trach tube. Suction depth varies depending on the size of the trach tube. The obturator can be used as a measuring guide.
Deep Suctioning: Insert the catheter until resistance is felt. (Deep suctioning is usually not necessary. Be careful to avoid vigorous suctioning, as this may injure the lining of the airway).

Signs That a Child Needs Suctioning
Rattling mucus sounds from the trach
Fast breathing
Bubbles of mucus in trach opening
Dry raspy breathing or a whistling noise from trach
Older children may vocalize or signal a need to be suctioned.
Signs of respiratory distress under Tracheostomy Complications

Equipment
Suction machine
Suction connecting tubing
Suction catheters
Normal saline
Sterile or clean cup
3cc saline ampules (“bullets”)
Ambu bag
Tissues
Gloves (optional for home care, use powder-free gloves)

Procedure

• Explain procedure in a way appropriate for child's age and understanding.


• Wash hands.


• Set up equipment and connect suction catheter to machine tubing.


• Pour normal saline into cup.


• Put on gloves (optional).


• Turn on suction machine (suction machine pressure for small children 50-100mm Hg, for older children/adults 100-120mm Hg)


• Place tip of catheter into saline cup to moisten and test to see that suction is working.


• Instill sterile normal saline with plastic squeeze ampule into the trach tube if needed for thick or dry secretions. Excessive use of saline is not recommended. Use saline only if the mucus is very thick, hard to cough up or difficult to suction. Saline may also be instilled via a syringe or eye dropper, which is less expensive than single dose units. Recommended amount per instillation is approximately 1cc.


• Gently insert catheter into the trach tube without applying suction. (Suction only length of trach tube - premeasured suctioning. Deeper insertion may be needed if the child has an ineffective cough.)


• Put thumb over opening in catheter to create suction and use a circular motion (twirl catheter between thumb and index finger) while withdrawing the catheter so that the mucus is removed well from all areas. Avoid suctioning longer than 10 seconds because of oxygen loss. Note: Some research has shown that by applying suction both going in and then out of the tube takes less time and therefore results there is less hypoxia. Also, there are now holes on all sides of the suction catheters, so twirling is not necessary.


• Draw saline from cup through catheter to clear catheter.


• For trach tubes with cuffs, it may be necessary to deflate the cuff periodically for suctioning to prevent pooling of secretions above trach cuff.


• Let child rest and breathe, then repeat suction if needed until clear (allow at least 30 seconds between suctioning).


• Oxygenate as ordered (extra oxygen may be given before and after suction to prevent hypoxia).


• Some children need extra breaths with an Ambu bag (approximately 3 - 5 breaths). Purposes of bagging: hyperoxygenation, hyperinflation, and hyperventilation of the lungs. However, this is usually not needed for stable children with no additional respiratory problems.


• The child's mouth or nose may also be suctioned, if needed after suctioning the trach, then dispose of that catheter (do not put same catheter back into trach).


• Dispose of suction catheter, saline and gloves, turn off machine. In home care, catheters may sometimes be used more than once before disposal or cleaning if child need frequent suctioning. Keep tip of catheter sterile, and store into original package.


• A bulb syringe may be used between suctioning if the child is able to cough up some secretions on his/her own.


• Be aware of color, odor, amount and consistency of the secretions and notify doctor of changes in secretions.

Pulmonary Concepts In Critical Care

Airway Management

AIRWAY MANAGEMENT

1. HUMIDIFICATION – heated cascade
   provides 100% humidification of inhaled gases. Ensure
   systemic hydration is monitored to help keep secretions
   thin.


2. AEROSOL THERAPY – nebulizers
   delivering aerosols increase secretion clearance and
   liquefy mucus; nebulizers may become a source of
   bacterial contamination.


3. CUFF MANAGEMENT – essential for
   prevention of necrosis and aspiration. Two different cuff-inflation
   techniques are currently used:


4. Minimal leak technique (ML) – inject
   air into cuff until no leak is heard and then withdrawing
   the air until a small leak is heard on inspiration. (Problems
   are related to maintaining PEEP, aspiration around the
   cuff, and increased movement of the tube.)


5. Minimal occlusive volume technique (MOV)
   – inject air into cuff until no leak is heard, then
   withdrawing the air until a small leak is heard on
   inspiration, and then adding more air until no leak is
   heard on inspiration. (Problems are related to higher
   cuff pressures than ML technique.) Use only if patient
   needs a seal to provide adequate ventilation and/or is at
   high risk for aspiration.


6. Monitor cuff pressures at least q. 8 h.
   Maintain pressure 18 to 22 mm Hg (25 to 30 cm H2O.
   Greater pressures decrease capillary blood flow in
   tracheal wall and lesser pressures increase risk of
   aspiration. Do not routinely deflate cuff.


7. POSTURAL DRAINAGE & POSITIONING (see
   respiratory references).


8. Key Point: Pneumonia = "Good lung
   down position"


9. ARDS = prone positioning for improved
   oxygenation


10. SUCTIONING – perform as sterile
    procedure only when patient needs it and not on a routine
    schedule. Observe for hypoxemia, atelectasis,
    bronchospasms, cardiac dysrhythmias, hemodynamic
    alterations, increased intracranial pressure, and airway trauma.

ENDOTRACHEAL/ TRACHEAL SUCTIONING PROCEDURE

OBJECTIVES:

The nurse performs endotracheal and tracheostomy suctioning to:

1. Maintain a patent airway.


2. To improve oxygenation and reduce the work of
   breathing.


3. To remove accumulated tracheobronchial secretions
   using sterile technique.


4. Stimulate the cough reflex.


5. Prevent pulmonary aspiration of blood and gastric
   fluids.


6. Prevent infection and atelectasis.

EQUIPMENT:
Sterile normal saline

Suction source

Ambu bag connected to 100% O2

Clear protective goggles/mask or face shield

Sterile gloves for open suction

Clean gloves for (in-line) closed suction

Sterile catheter with intermittent suction control port or In-line
suction catheter

PROCEDURE:

1. Wash hands. Reduces transmission of
microorganisms.

2. Assess patient’s need for
suctioning. Since endotracheal suctioning can be hazardous
and causes discomfort, it is not recommended in the absence
of apparent need.

Coarse breath sounds

Coughing; increased respirations

Increased PIP on ventilator

3. Don goggles and mask or face shield.
Potential for contamination

4. Turn on suction apparatus and set vacuum
regulator to appropriate negative pressure. Recommend 80-120
mmHg; adjust lower for children and the elderly. Significant
hypoxia and damage to tracheal mucosa can result from
excessive negative pressure.

5. Prepares suction apparatus. Secure one
end of connecting tube to suction machine, and place other
end in a convenient location within reach.

6. Use in-line suction catheter or open
sterile package (catheter size not exceeding one-half the
inner diameter of the airway) on a clean surface, using the
inside of the wrapping as a sterile field.

7. Prepares catheter and prevents
transmission of microorganisms. Catheter exceeding one-half
the diameter increases possibility of suction-induced hypoxia
and atelectasis.

8. Prepare catheter flush solution.With in-line
catheter use sterile saline bullets to flush catheter. With
regular suctioning set up sterile solution container and
being careful not to touch the inside of the container, fill
with enough sterile saline or water to flush catheter.

9. With in-line suction catheter use clean
gloves. With regular suctioning, done sterile gloves.
Maintain sterility. Universal precautions. In regular
suctioning the dominant hand must remain sterile throughout
the procedure.

10. Pick up suction catheter, being careful
to avoid touching nonsterile surfaces. With nondominant hand,
pick up connecting tubing. Secure suction catheter to
connecting tubing. Maintains catheter sterility. Connects
suction catheter and connecting tubing

11. Ensures equipment function. Check
equipment for proper functioning by suctioning a small amount
of sterile saline from the container. (skip this step in in-line
suctioning)

12. Remove or open oxygen or humidity
device to the patient with nondominant hand. (skip this step
with in-line suctioning). Opens artificial airway for
catheter entrance. Have second person assist when indicated
to avoid unintentional extubation.

13. Replace O2 delivery device or reconnect
patient to the ventilator. Hyperoxygenate and hyperventilate
via 3 breaths by giving patient additional manual breaths on
the ventilator before suctioning. Hyperoxygenation with 100%
O2 is used to offset hypoxemia during interrupted oxygenation
and ventilation. Preoxygenation offsets volume and O2 loss
with suctioning. Patients with PEEP should be suctioned
through an adapter on the closed suction system.

14. Without applying suction, gently but
quickly insert catheter with dominant hand during inspiration
until resistance is met; then pull back 1-2 cm. Catheter is
now in tracheobronchial tree. Application of suction pressure
upon insertion increases hypoxia and results in damage to the
tracheal mucosa.

15. Apply intermittent suction by placing
and releasing dominant thumb over the control vent of the
catheter. Rotate the catheter between the dominant thumb and
forefinger as you slowly withdraw the catheter. With in-line
suction, apply continuous suction by depressing suction valve
and pull catheter straight back. Time should not exceed 10-15
seconds. Intermittent suction and catheter rotation prevent
tracheal mucosa when using regular suctioning methods. Unable
to rotate with closed- suction method.

16. Replace oxygen delivery device.
Hyperoxygenate between passes of catheter and following
suctioning procedure. Replenishes O2. Recovery to base PaO2
takes 1 to 5 minutes. Reduces incidence of hypoxemia and
atelectasis.

17. Rinse catheter and connecting tubing
with normal saline until clear. Removes catheter secretions.

18. Monitor patient’s cardiopulmonary
status during and between suction passes. Observe for signs
of hypoxemia, e.g. dysrhythmias, cyanosis, anxiety,
bronchospasms, and changes in mental status.

19. Once the lower airway has been
adequately cleared of secretions, perform nasal and oral
pharyngeal or upper airway suctioning. Removes upper airway
secretions. The catheter is contaminated after nasal and oral
pharyngeal suctioning and should not be reinserted into the
endotracheal or tracheostomy tube.

20. Upon completion of upper airway
suctioning, wrap catheter around dominant hand. Pull glove
off inside out. Catheter will remain in glove. Pull off other
glove in same fashion and discard. Turn off suction device.
Reduces transmission of microorganisms.

21. Reposition patient. Supports
ventilatory effort; promotes comfort; communicates caring
attitude.

22. Reassess patient’s respiratory
status. Indicates patient’s response to suctioning

23. Dispose of suction liners and
connecting tubing, sterile saline solution every 24 hours and
set up new system. Decreases incidence of organism
colonization and subsequent pulmonary contamination.
Universal precautions.

PRECAUTIONS:

1. Minimize suctioned-induced atelectasis and hypoxemia:

a. Avoid using catheters larger than one-half the
diameter of the airway.

b. Administer one or more postsuctioning
hyperinflations, using manual or sigh breaths on the
ventilator or ambu bag if not ventilated.

2. Maintain rigorous sterile technique when suctioning the
intubated patient. Impaired pulmonary defense systems and
invasive instrumentation of the pulmonary tract predisposes
these patients to colonization and infection. Never use same
catheter to suction the trachea after it has been used in the
nose or the mouth.

3. Limit the frequency of suctioning and avoid, as much as
possible, catheter impaction in the bronchial tree when the
patient is anticoagulated or when hemorrhage from suction-induced
trauma is evident.

4. Minimize the frequency and duration of suctioning when
patient is on positive end-expiratory pressure (PEEP) greater
than 5 cm or continuous positive airway pressure (CPAP).
Small suctioning-induced changes may have profound effects on
these marginally oxygenated patients.

5. Maintain awareness of the limitations of ET/tracheal
suctioning. Maneuvers and catheter design have been proposed
to increase the likelihood of passage into the left bronchus;
however, these have been shown to be of limited success.
Because the left main stem bronchus emerges from the trachea
at the 45-degree angle from the vertical, suction catheters
are almost inevitable passed into the right bronchus (when
they pass the carina) despite head-turning, etc.

6. The use of saline installations for loosening
secretions has been controversial and recent research shows
that in fact it is detrimental and poses a greater risk of
pneumonia for the patient.

RELATED CARE:

1. Include strategies to move secretions through
peripheral airways. These measures are: appropriate hydration
and adequate humidification of inspired gases (to keep
secretions thin); coughing and deep breathing; frequent
position changes (may need rotation bed); chest
physiotherapy; and bronchodilating agents as ordered.

2. Monitor the patient carefully during ET/tracheal
suctioning for ectopic dysrhythmias aggravated by suction-induced
hypoxemia and other dysrhythmias, particularly conduction
disturbances, related to catheter irritation of vagal
receptors within the respiratory tract (requires immediate
cessation of suctioning and hyperoxygenation).

POTENTIAL COMPLICATIONS

Hypoxemia

Atelectasis

Dysrhythmias

Nosocomial pulmonary tract infection

Sepsis

Mucosal trauma with increase secretions

Cardiac arrest