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Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
In both shockable and non-shockable sides of the algorithm, there is much to be done to improve the patient’s chances of survival.The most important task is maintenance of high-quality CPR.The gold standard for protecting the airway is tracheal intubation but this can only be performed by someone expert in the technique. Until this point, ensure ventilation is achieved by whichever means you are competent to perform.Once tracheal intubation is achieved, ventilations can be administered at a rate of 10 per minute without stopping compressions.Once tracheal intubation has been undertaken, waveform capnography should be used.Intravenous access should be obtained as soon as possible.If it is not possible to achieve intravenous access, intraosseous access may be considered, using either the tibia or the humerus. Either drugs or fluids can be administered via this route.
Practical Procedures
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Tracheal intubation considered impossible, or unacceptably high risk: Severe maxillofacial trauma.Massive oedema of the throat tissues (e.g. angioedema, airway burns).Severe trismus or clenched teeth; masseter spasm after suxamethonium.Foreign body/tumour blocking upper airway.
Fiber-optic intubation
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Prasanna Udupi Bidkar, K. Narmadhalakshmi
The landmarks for tracheal intubation are the epiglottis, glottis, tracheal rings, and carina (Figure 36.7). When the tip of the scope is just above the carina, the scope is held firmly at that position. Look at the depth mark at the level of the incisors. Ask the assistant to release the endotracheal tube and pass it over the scope. The tube is gently advanced under vision via naso/oropharynx, pharynx, and larynx. Confirm the tip of the endotracheal tube in relation to the carina and withdraw the scope. The tip of the scope should be neutral while advancing the tracheal tube and withdrawing the endoscope.
An innovative virtual reality training tool for the pre-hospital treatment of cranialmaxillofacial trauma
Published in Computer Assisted Surgery, 2023
Jin Lu, Ao Leng, Ye Zhou, Weihao Zhou, Jianfeng Luo, Xiaojun Chen, Xiangdong Qi
The main process of the medical activities is shown in Figure 6. After switching to the rescue scenario, the first step is to remove foreign bodies in the respiratory tract. Remove foreign bodies with fingers or suction device according to the instructions. The second step is tracheal intubation. The patient is placed in a supine position, and the forehead is pressed and the chin is lifted so that the mouth, pharynx and trachea are basically in the same axis. The operator is positioned on the side of the head, with the patient’s lips open in the right hand and the laryngoscope in the left hand, and the vocal hilum is visible by lifting up the laryngoscope. After exposing the glottis, the catheter is gently inserted into the trachea, the dental pad is placed, and the laryngoscope is withdrawn.
Efficacy of dexmedetomidine-based opioid-free anesthesia on the control of surgery-induced inflammatory response and outcomes in patients undergoing open abdominal hysterectomy
Published in Egyptian Journal of Anaesthesia, 2022
Mohamed A Lotfy, Mohamed G Ayaad
Anesthesia was induced by propofol 2 mg/kg, rocuronium 0.5 mg/kg for patients of OB-GA, while was induced using the loading doses of DEX and LID directly intravenously for patients of OF-GA. For patients of both groups, tracheal intubation was aided by gentle tracheal pressure, and an endotracheal tube measuring 6.5 mm was inserted. After intubation of the trachea, the lungs were ventilated with 100% O2 in the air using a semi-closed circle system. For patients of the OF-GA group, DEX and LID infusions were applied at a rate of 0.3 ml/kg/h and 2 mg/kg/h, respectively. During surgery, ventilation was controlled with a tidal volume of 6–8 ml/kg, and the ventilatory rate was adjusted to maintain an end-tidal carbon dioxide (paCO2) of 32–35 mmHg. For intraoperative analgesia fentanyl, 1 µg/kg was given for patients of OB-GA and adjustment of infusions’ rates for patients of OF-GA. Anesthesia was maintained with sevoflurane 1.7 MAC and top-up doses of rocuronium if needed. Muscle relaxant was reversed using neostigmine 0.05 mg/kg with atropine 0.01 mg/kg.
The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review
Published in Expert Review of Medical Devices, 2022
Trias Mahmudiono, Saurabh Singhal, Anas Amer Mohammad, Virgilio E Failoc-Rojas, Maria Jade Catalan Opulencia, Angel Santillán Haro, Yasir Salam Karim, Nizom Qurbonov, Walid Kamal Abdelbasset, Ahmed B. Mahdi, Yasser Fakri Mustafa
There are sparse data regarding the impact of the aerosol box on intubation time. Some studies have shown that the use of aerosol box leads to an increase in intubation time, and this is statistically significant [24,25,30,31,35,36,39,42]. However, there were a number of studies reporting no significant differences in the time to intubation with and without the aerosol box [32,38,40]. The findings of other systematic reviews dedicated to the intubation box showed that intubation time was significantly longer when using the aerosol box [20,55,60]. Moreover, it was reported that intubation time was relatively shorter when intubation was carried out by more experienced proceduralists using the video laryngoscopy [60]. Of note, the video laryngoscopy is a helpful tool in difficult airway management that facilitates the tracheal intubation maneuver by visualizing the patient’s larynx through a fiber-optic camera integral to a laryngoscope blade to indirectly display it on a monitor [61]. Several studies have widely reported the superiority of video laryngoscopy compared to direct laryngoscopy for glottic visualization, particularly in cases of difficult tracheal intubation [62–64]; as the video laryngoscopes are the recommended devices to perform tracheal intubation according to the different guidelines [65–68].