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[DYSPHAGIA] TBI and CSF leak



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Lana,

I'm no expert on pressure but unles your patient keeps his mouth and nose 
closed I can't see how pressure would build up.

David M. Zirlen, M.S., C.C.C.
Speech-Language Pathologist
Waterbury Hospital
Waterbury, CT
Zirlen & Zirlen Speech Pathologist
Chester, CT

In a message dated 11/30/01 5:16:46 PM Eastern Standard Time, 
lbenson@capefearvalley.com writes:


> Sorry if this is a little off topic.  
> I have a 25 y/o male who was involved in a parachute accident one month 
> ago.  He has a severe traumatic brain injury with multiple comminuted 
> (shattered like) fractures involving the clivus (sphenoid bone), sinuses, 
> orbits, frontal and vertex of the skull.  Per the CT report -pt has 
> complete disruption of the floor of the anterior cranial fossa.  He also 
> has bilateral maxillary fractures( along with some lower extremity bones 
> broken).  He currently has a trach and we have been using the Passy Muir 
> Speaking Valve.  He tolerates it very well- over an hour at a time with O2 
> sat remaining 97-100 with only mild decreased vocal intensity.  He does 
> cough intermittently with the speaking valve on (and off).   They have 
> recently diagnosed him as having a Cerebral Spinal Fluid (CSF) leak.  
> Physical therapy reports drainage through his nose of CSF when they sit him 
> up.  He is currently NPO and likely his intermittent coughing is on the CSF 
> and secretions.  My question is- would the change in pressure with use of 
> the Passy Muir Speaking Valve have a negative effect on his CSF leak.  Is 
> there any reason to hold use of the speaking valve?  
> Thank you for any input you may have.  
> Lana Shivak-Benson MS CCC-SLP 
> 
> 
> 



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<HTML><FONT FACE=arial,helvetica><FONT  SIZE=2>Lana,
<BR>
<BR>I'm no expert on pressure but unles your patient keeps his mouth and nose closed I can't see how pressure would build up.
<BR>
<BR>David M. Zirlen, M.S., C.C.C.
<BR>Speech-Language Pathologist
<BR>Waterbury Hospital
<BR>Waterbury, CT
<BR>Zirlen &amp; Zirlen Speech Pathologist
<BR>Chester, CT
<BR>
<BR>In a message dated 11/30/01 5:16:46 PM Eastern Standard Time, lbenson@capefearvalley.com writes:
<BR>
<BR>
<BR><BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">Sorry if this is a little off topic. &nbsp;
<BR>I have a 25 y/o male who was involved in a parachute accident one month ago. &nbsp;He has a severe traumatic brain injury with multiple comminuted (shattered like) fractures involving the clivus (sphenoid bone), sinuses, orbits, frontal and vertex of the skull. &nbsp;Per the CT report -pt has complete disruption of the floor of the anterior cranial fossa. &nbsp;He also has bilateral maxillary fractures( along with some lower extremity bones broken). &nbsp;He currently has a trach and we have been using the Passy Muir Speaking Valve. &nbsp;He tolerates it very well- over an hour at a time with O2 sat remaining 97-100 with only mild decreased vocal intensity. &nbsp;He does cough intermittently with the speaking valve on (and off). &nbsp;&nbsp;They have recently diagnosed him as having a Cerebral Spinal Fluid (CSF) leak. &nbsp;Physical therapy reports drainage through his nose of CSF when they sit him up. &nbsp;He is currently NPO and likely his intermittent coughing is on the CSF and secretions. &nbsp;My question is- would the change in pressure with use of the Passy Muir Speaking Valve have a negative effect on his CSF leak. &nbsp;Is there any reason to hold use of the speaking valve? &nbsp;
<BR>Thank you for any input you may have. &nbsp;
<BR>Lana Shivak-Benson MS CCC-SLP 
<BR></FONT><FONT  COLOR="#000000" SIZE=3 FAMILY="SANSSERIF" FACE="Arial" LANG="0">
<BR>
<BR></FONT><FONT  COLOR="#000000" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0"></BLOCKQUOTE>
<BR>
<BR></FONT></HTML>

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