أبريل 13, 2017
DEFINITION
tried endotracheal intubation below direct imaginative and prescient with trendy gadget that isn't achieved after attempts.
reasons
▪ insufficient instruction / approach - most common purpose of a tough endotracheal intubation
▪ Anatomical
● Neck : short "bull" neck congenital abnormalities
● Mandible : small, large
● enamel : strange dentition, in particular "dollar tooth"
● Larynx : anterior caudal larynx
● different : immoderate facial hair being pregnant (advanced)
▪ Pathological
● Trauma - to the face or neck (blunt, penetrating, burns)
● Connective tissue disorder affecting the mobility of the neck or mandible
● Goitre or other mass in the neck
● obesity
● Airway obstruction (foreign frame, epiglottitis)
assessment
▪ records of previous troubles with airway methods, connective tissue disorder etc
▪ physical evaluation
● capability to visualise the smooth palate, and particularly the uvula
● ability to increase the head
● recessed chin
● sizeable top airway bleeding
● airway burns or anatomical disruption because of trauma, mass and many others.
training AND PREVENTION
training has three components :
1. The system
2. The patient
three. The team of workers
control
wherein hard intubation is anticipated
● name a health practitioner skilled in airway control before graduation (if time allows)
● before taking off, examine whether the patient's airway and respiration can be maintained the use of the bag valve mask.
● Plan to attempt laryngoscopy underneath sedation best ie avoid the use of neuromuscular blockers if feasible.
● Have the hard airway tray handy
in which hard intubation happens
1. forestall-Reoxygenate-rethink
¤ put off ETT
¤ try to re-ventilate /re-oxygenate with bag valve masks attached to oxygen in mixture with simple airway establishing manoeuvres eg jaw thrust, nasopharyngeal tube
¤ Ask - why did the intubation fail? eg wrong head function, incorrect sized laryngoscope blade, insufficient training?
- is the intubation pressing?
- can oxygenation be maintained?
- what is the risk of aspiration?
2. Then If
can't Intubate / Can Ventilate
¤ alternatives :
- manipulate the larynx - Backward Upward right strain (see later)
- Airway bougie (see later)
can not intubate / can not Ventilate
¤ alternatives :
- Laryngeal mask - size 2 for youngsters
- size four for adults permits - nice pressure ventilation
- passage of bougie as above to facilitate intubation
- passage of a 6mm uncuffed ETT thru the lumen and into the trachea (see later)
3. If this Fails - Surgical Airway
¤ Transtracheal jet insufflation
OR
¤ Cricothyroidotomy
critical points
1. Predetermine lines of referral for senior scientific backup if viable.
2. Be prepared with properly trained workforce and frequently checked system, along with a difficult Airway Tray.
three. investigate the patient for proof of possible problems earlier than starting up the manner (if time permits)
four. if you are not an experienced intubator or difficult intubation is anticipated, summon senior assist early.
five. where tough intubation is anticipated, try initial laryngoscopy under sedation by myself before giving neuromuscular blockers.
6. If hard intubation is encountered, forestall, Re-Oxygenate, Re-assume.
tried endotracheal intubation below direct imaginative and prescient with trendy gadget that isn't achieved after attempts.
reasons
▪ insufficient instruction / approach - most common purpose of a tough endotracheal intubation
▪ Anatomical
● Neck : short "bull" neck congenital abnormalities
● Mandible : small, large
● enamel : strange dentition, in particular "dollar tooth"
● Larynx : anterior caudal larynx
● different : immoderate facial hair being pregnant (advanced)
▪ Pathological
● Trauma - to the face or neck (blunt, penetrating, burns)
● Connective tissue disorder affecting the mobility of the neck or mandible
● Goitre or other mass in the neck
● obesity
● Airway obstruction (foreign frame, epiglottitis)
assessment
▪ records of previous troubles with airway methods, connective tissue disorder etc
▪ physical evaluation
● capability to visualise the smooth palate, and particularly the uvula
● ability to increase the head
● recessed chin
● sizeable top airway bleeding
● airway burns or anatomical disruption because of trauma, mass and many others.
training AND PREVENTION
training has three components :
1. The system
2. The patient
three. The team of workers
control
wherein hard intubation is anticipated
● name a health practitioner skilled in airway control before graduation (if time allows)
● before taking off, examine whether the patient's airway and respiration can be maintained the use of the bag valve mask.
● Plan to attempt laryngoscopy underneath sedation best ie avoid the use of neuromuscular blockers if feasible.
● Have the hard airway tray handy
in which hard intubation happens
1. forestall-Reoxygenate-rethink
¤ put off ETT
¤ try to re-ventilate /re-oxygenate with bag valve masks attached to oxygen in mixture with simple airway establishing manoeuvres eg jaw thrust, nasopharyngeal tube
¤ Ask - why did the intubation fail? eg wrong head function, incorrect sized laryngoscope blade, insufficient training?
- is the intubation pressing?
- can oxygenation be maintained?
- what is the risk of aspiration?
2. Then If
can't Intubate / Can Ventilate
¤ alternatives :
- manipulate the larynx - Backward Upward right strain (see later)
- Airway bougie (see later)
can not intubate / can not Ventilate
¤ alternatives :
- Laryngeal mask - size 2 for youngsters
- size four for adults permits - nice pressure ventilation
- passage of bougie as above to facilitate intubation
- passage of a 6mm uncuffed ETT thru the lumen and into the trachea (see later)
3. If this Fails - Surgical Airway
¤ Transtracheal jet insufflation
OR
¤ Cricothyroidotomy
critical points
1. Predetermine lines of referral for senior scientific backup if viable.
2. Be prepared with properly trained workforce and frequently checked system, along with a difficult Airway Tray.
three. investigate the patient for proof of possible problems earlier than starting up the manner (if time permits)
four. if you are not an experienced intubator or difficult intubation is anticipated, summon senior assist early.
five. where tough intubation is anticipated, try initial laryngoscopy under sedation by myself before giving neuromuscular blockers.
6. If hard intubation is encountered, forestall, Re-Oxygenate, Re-assume.
