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Published in Marilyn Sue Bogner, Human Error in Medicine, 2018
Anesthesia is initially induced with an intravenous induction agent that acts very rapidly and places the patient in a relatively deep level of anesthesia. However, these drugs typically have a very short duration of action (5-10 min or less) so that anesthesia must be maintained using one or more other drugs. A variety of drugs and techniques can be used to maintain anesthesia. When anesthesia is induced, the patient will need respiratory support. Even if the patient can breathe spontaneously, special tools and techniques may be needed to keep the airway open. For the majority of cases, it is advantageous to provide a direct route of gases into the lungs, so an endotracheal tube is placed through the mouth (or occasionally the nose) into the windpipe (trachea) and connected to the anesthesia system. A cuff on the tube provides an airtight seal. To place the tube usually requires that the patient’s muscles be paralyzed (at least for a short time) with a drug like Curare. Placing the endotracheal tube is usually easy, but in some patients due to their anatomy, it is very difficult or even impossible using standard techniques. Most cases involve artificial ventilation by using a breathing bag or ventilator.
Coanda Effect in a Human Body
Published in Noor A. Ahmed, Coanda Effect, 2019
Endotracheal intubation is generally performed when a patient is placed on a ventilator during anesthesia or serious illness. In this procedure, a tube called an endotracheal tube, is inserted through the mouth and into the airway of the patient. The endotracheal tube then acts as an artificial windpipe that connects the pharynx. The pharynx branches into the two bronchi to finally connect the lungs to supply air. The intubation process [45] is shown in Figure 5.15.
Resources of Strength: An Exnovation of Hidden Competences to Preserve Patient Safety
Published in Emma Rowley, Justin Waring, A Socio-cultural Perspective on Patient Safety, 2017
The positioning of an endotracheal tube is essential for providing respiratory support. For most NICU patients, respiratory support plays a central role in the treatment. To allow the respirator to insert a mixture of air and oxygen into the lungs of the baby, a tube is inserted into the infant’s nose (or mouth), passing the glottis (the space between vocal cords in the voice box) into the windpipe. This procedure cannot be performed by a single person and is quite risky. In a teaching hospital the procedure involves a resident, a supervising neonatologist and two nurses. Considering the risks involved and the collaborative nature of this intervention, this procedure serves as a useful case to demonstrate how diagnostic work is an integral part of safe, collaborative medical practice and how temporal orders are accommodated in this process. A preparatory stage of an intubation procedure involves anticipation of the near future. This is expressed in the assessment of the condition of the baby and the arrangement of the instruments. Before the actual intubation is started, a nurse collects and checks the equipment. Next the neonatologist and the resident who has to do the actual intubation, double-check the presence and functioning of the equipment. They need to be sure that everything is connected correctly. However, checking equipment is more than just turning switches on and off. A thorough check presumes full understanding of the purpose of instruments, so as to be able to assess their proper working. NICU: The neonatologist picks up the laryngoscope and switches its light on and off and hands it over to the resident who is doing the same thing. ‘Before you start, always double-check if everything is here and make sure it works. You cannot afford any delay because something is missing or doesn’t work.’ Next the resident takes the oxygen-bag and squeezes it. Then she picks up the mask and holds it near the baby’s face. Together they discuss how to measure the right size of the mask and tube. Then they turn around to check the respiratory machine and the monitor behind the incubator. After being sure everything functions properly the neonatologist switches off the alarm of the monitor: ‘let’s have some tranquillity over here’.
A mechatronic simulator for learning surgical procedures
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
C. Brèque, J. Danion, E. Oriot, T. Vendeuvre, J. P Faure, G. Donatini, D. Oriot, J. P Richer
Since 2013, we have developed a mechatronic system (called P4P ‘Pulse for Practice’) designed to be connected to a human body resulting from donation of the body to science and is acquiring the know-how to simulate ventilation and circulation on this human body, according to specifications defined by practitioners. As soon as bodies arrive in the center, they are prepared for this purpose. This involves draining the native blood from the body, and replacing it with a viscous liquid, by placing cannulas in the carotid and femoral vessels and using an injection pump. Cannulas are also introduced into the satellite veins of these arteries. Native human blood, which coagulates, is replaced by a liquid with the same mechanical properties, but without the coagulation effect (clots). An endotracheal tube is inserted into the trachea or a tracheostomy is performed to ventilate the lungs. The upper and lower limbs, as well as the cephalic end, are excluded through proximal ligatures at the venous and arterial levels so that only the trunk is re-vascularized. After 2 to 3 hours of preparation, the body is frozen at −20 °C with vascular cannulas and tracheostomy, without any preservative chemicals and thawed 3 days before using the model (Figure 1).
Designing A Video Laryngoscope Imaging System with A 7-mm Blade for Neonatal Patients
Published in Smart Science, 2018
Ming-Ying Hsu, Wen-Tse Hsiao, Han-Chao Chang
According to the anatomy and hypopharyngeal position, the ‘sniffing position’ [3] is considered an optimal intubation posture for a patient (Figure 2). After placing a patient in this position, the endotracheal tube is inserted through the mouth and then through the glottis into the trachea to form an airway, allowing air or oxygen to pass through the channel to and from the lungs. Depending on whether the soft palate, uvula, throat, and glottis are visible, the difficulty of endotracheal intubation can be divided into Mallampati I–IV grades [3] (Figure 3). However, 30–40% cases of surgical anesthesia deaths still result from difficult intubations [4,5]. In recent years, doctors have also been using German- or American-made video laryngoscopes; however, these laryngoscopes have several clinical limitations, such as their blade size (12 mm) [2,6] is too large for Asian newborns and their image’s depth of field (DOF) is insufficient. Moreover, the Miller design (blade size 1) and its steps of operation are textbook examples that teach doctors regarding the intubation of newborns and children aged under 2 years; thus, most doctors are familiar with Miller-designed products. By contrast, the Macintosh design (blade size 1) is relatively recently introduced in the past decade; thus, it is not so widely used. Passi et al. [7] compared the intubation practices of two blade designs for 50 newborns and children aged <2 years. They found that optimal laryngeal views may be obtained using either the Miller design by lifting the epiglottis or using the Macintosh design by lifting the tongue base. Therefore, in the present study, 7-mm Macintosh-designed ultrathin blades were used, and a set of 2.5-mm image acquisition modules were developed to solve the DOF problem to provide a new imaging optical system for improved neonatal intubations.