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軒名 林The document discusses criteria for determining when a patient can be safely removed from mechanical ventilation, including assessments of respiratory, cardiovascular and mental status. It describes methods used to identify patients who can tolerate a spontaneous breathing trial, such as the rapid shallow breathing index. The document also outlines protocols for conducting spontaneous breathing trials through a ventilator or T-piece and managing issues that could arise like respiratory failure, low cardiac output, or laryngeal edema.
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Extubation protocol in the OR and ICU
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Extubation-Making the Unpredictable Safer
This document proposes a new algorithm for extubating patients called "VSS+4S+2S". It notes that while considerable research has focused on intubation, relatively little attention has been given to developing standardized guidelines and protocols for safe extubation. The proposed algorithm aims to improve extubation practices, minimize failures, and provide a practical framework for teaching residents. It consists of evaluating Vital Signs Stability, then Stent, Strength, Spontaneous breathing, and Suctioning the patient while still under anesthesia. Once these criteria are met, anesthesia is discontinued and the return of Swallowing and ability to Secure the airway are assessed before full extubation. The goal is to establish standardized steps to guide ext
Post extubation stridor
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
Extubation and reintubation
This document discusses guidelines for extubation and managing risks associated with extubation. It begins by outlining criteria that must be met for safe extubation, such as adequate breathing and hemodynamics. It then describes methods for standard, awake, deep and difficult/high risk extubations. Risks of immediate extubation are outlined. The document provides detailed protocols for managing complications like laryngospasm and laryngeal edema to prevent reintubation. Prophylactic medications, strategies for difficult airways, and criteria for determining pre-extubation airway edema are discussed to ensure extubations are performed safely.
Extubation failure
Extubation failure is defined as the need for reintubation within 24-72 hours after removal of an endotracheal or tracheostomy tube. Predictors of extubation failure include respiratory mechanics measures like rapid shallow breathing index and airway occlusion pressure. Other predictors are neurologic impairment, weak cough strength, excessive secretions, positive fluid balance, and acute cardiac dysfunction. Management of extubation failure involves treating the underlying causes, continued ventilation, non-invasive ventilation, diuretics, and prophylactic steroids to prevent laryngeal edema. Extubation success relies on careful assessment of neuro-muscular, respiratory, airway, and cardiovascular status to identify patients at risk and intervene early.
Tracheal extubation
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
The difficult extubation
The document discusses the top five post-extubation emergencies: laryngospasm, laryngeal stridor, acute hypoxemia, acute respiratory failure, and neurologic pathology. It provides definitions and discusses how to potentially predict and treat each emergency. Key points include that extubations should not be treated as routine, extensive assessment is important, and having difficult intubation supplies available is critical in case re-intubation is needed. The document emphasizes being prepared for potential post-extubation complications.
Extubation problems and its management
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
Recommended
Extubation protocol in the OR and ICU
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Extubation-Making the Unpredictable Safer
This document proposes a new algorithm for extubating patients called "VSS+4S+2S". It notes that while considerable research has focused on intubation, relatively little attention has been given to developing standardized guidelines and protocols for safe extubation. The proposed algorithm aims to improve extubation practices, minimize failures, and provide a practical framework for teaching residents. It consists of evaluating Vital Signs Stability, then Stent, Strength, Spontaneous breathing, and Suctioning the patient while still under anesthesia. Once these criteria are met, anesthesia is discontinued and the return of Swallowing and ability to Secure the airway are assessed before full extubation. The goal is to establish standardized steps to guide ext
Post extubation stridor
The document discusses post-extubation stridor, which is upper airway obstruction that can occur after a patient is extubated from a ventilator. It defines post-extubation stridor and reviews risk factors such as duration of intubation and cuff pressures. The cuff leak test is presented as a way to identify patients at risk. Studies are reviewed showing steroids given before extubation can reduce the risk of stridor. Clinically, it recommends identifying at-risk patients, performing the cuff leak test, and considering steroid treatment for high-risk patients before extubation.
Extubation and reintubation
This document discusses guidelines for extubation and managing risks associated with extubation. It begins by outlining criteria that must be met for safe extubation, such as adequate breathing and hemodynamics. It then describes methods for standard, awake, deep and difficult/high risk extubations. Risks of immediate extubation are outlined. The document provides detailed protocols for managing complications like laryngospasm and laryngeal edema to prevent reintubation. Prophylactic medications, strategies for difficult airways, and criteria for determining pre-extubation airway edema are discussed to ensure extubations are performed safely.
Extubation failure
Extubation failure is defined as the need for reintubation within 24-72 hours after removal of an endotracheal or tracheostomy tube. Predictors of extubation failure include respiratory mechanics measures like rapid shallow breathing index and airway occlusion pressure. Other predictors are neurologic impairment, weak cough strength, excessive secretions, positive fluid balance, and acute cardiac dysfunction. Management of extubation failure involves treating the underlying causes, continued ventilation, non-invasive ventilation, diuretics, and prophylactic steroids to prevent laryngeal edema. Extubation success relies on careful assessment of neuro-muscular, respiratory, airway, and cardiovascular status to identify patients at risk and intervene early.
Tracheal extubation
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
The difficult extubation
The document discusses the top five post-extubation emergencies: laryngospasm, laryngeal stridor, acute hypoxemia, acute respiratory failure, and neurologic pathology. It provides definitions and discusses how to potentially predict and treat each emergency. Key points include that extubations should not be treated as routine, extensive assessment is important, and having difficult intubation supplies available is critical in case re-intubation is needed. The document emphasizes being prepared for potential post-extubation complications.
Extubation problems and its management
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
Extubation presentation
This document discusses the criteria and process for extubating a patient from mechanical ventilation. It begins by defining extubation as the removal of the endotracheal tube, which should only be done once a patient no longer requires ventilation and can protect their airway. Specific criteria are provided for assessing a patient's readiness, including hemodynamic stability, adequate oxygenation, normal blood gases, resolution of underlying conditions, and intact neurological function. Potential complications are also reviewed. The process of extubation involves preparing equipment, explaining to the patient, continuously monitoring their condition, and carefully removing the tube while suctioning and assessing airway patency.
Rapid Sequence Intubation
This document discusses rapid sequence intubation (RSI) for airway management in the pre-hospital setting. It outlines the philosophy of RSI, including that it should only be used if absolutely necessary due to risks. The document provides guidance on RSI techniques, medications, equipment, and verification of proper endotracheal tube placement. Several studies are referenced that show risks of RSI including increased mortality rates, hypoxia, and worse outcomes for head injured patients compared to bag-valve-mask ventilation alone. Proper training and only using RSI for prolonged transports are emphasized.
Raj care laryngospasm ppt
Laryngospasm is a protective reflex that causes glottic closure to prevent aspiration. It can impede respiration if sustained. While rare, it is most commonly seen during emergence from anesthesia. Complete laryngospasm with closure of the vocal cords poses risks like hypoxia, while partial laryngospasm can be treated by removing stimuli, positioning, airway maneuvers, sedation or muscle relaxants. Prevention focuses on identifying at-risk patients and using non-irritating anesthesia to minimize stimuli during intubation and extubation.
Airway management in critical care
- Emergency intubations outside the operating room in critically ill patients carry a high risk of failure and adverse events due to patient factors like pulmonary issues and obesity that make preoxygenation less effective.
- Multiple techniques can be used together to optimize preoxygenation and apneic oxygenation, including various positions, CPAP, PEEP, and nasal cannulas to prolong safe apnea time and reduce desaturation risks.
- It is important to have alternative plans prepared in case of intubation difficulties, to get help early, and carefully consider risks and benefits of intubation for any given patient.
Airway solutions in trauma scenarios
1) The patient, a 28-year old man involved in a motorbike accident, has an impaired airway as evidenced by snoring, rapid breathing, and low oxygen saturation.
2) The top priority is securing the patient's airway. Basic airway maneuvers and adjuncts like chin lift, jaw thrust, oropharyngeal airway are appropriate first steps given intact reflexes.
3) If the airway cannot be maintained or there is impending compromise, more invasive techniques like intubation may be needed while protecting the cervical spine. Assessing risk factors can help predict difficult airways requiring specialized equipment or procedures like surgical airway.
Intubation in critical care setting
This document discusses intubation in critical care settings. It notes that ICU intubations carry high risks, with 25% of patients experiencing severe hypoxemia and 60% of airway incidents resulting in death or neurological injury. Difficulties arise from factors relating to the patient, staff, and environment. The MACOCHA score can help predict difficult airways. The Difficult Airway Society guidelines recommend preparation, checklists, backup plans including front-of-neck access, and continuous monitoring after intubation to reduce risks from these high-stakes procedures in critically ill patients.
Difficult airway guidelines paeds
1) The document provides guidelines for managing difficult airways in pediatrics, outlining a 3-step approach including laryngoscopy and intubation, use of a supraglottic airway device, and emergency surgical access if ventilation fails.
2) It discusses the anatomical and physiological differences between children and adults that increase airway management challenges in pediatrics.
3) Adjuvants like video laryngoscopy, passive oxygenation, and ultrasound guidance are reviewed as tools that can help extend the safe apnea time and improve visualization or placement of airway devices in children.
Airway Management
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
1. tracheostomy, Cricothyrotomy, PDT
Tracheostomy is a surgical procedure that creates an opening in the trachea to allow direct access to the breathing tube. It has several indications including bypassing upper airway obstruction, removing secretions from the lungs, and facilitating prolonged mechanical ventilation. There are different types of tracheostomies based on location and whether they are temporary or permanent. Potential complications include bleeding, infection, and tracheal stenosis. Proper care including suctioning, humidification, and dressing changes can help prevent complications. Percutaneous dilational tracheostomy is a minimally invasive technique to perform tracheostomy at the bedside using guidewires and dilation. Decannulation involves gradually removing the tracheostomy tube when the original condition improves
Extubation from Ventilator
The document discusses guidelines for extubation in pediatric patients. It states that a patient should be capable of maintaining an airway and spontaneous ventilation before extubation. It also discusses assessing readiness for extubation and managing potential post-extubation issues like stridor. Precautions should be taken and equipment available to address any complications. An acceptable extubation failure rate is reported to be between 10 to 19 percent.
Bronchoscopy, Diagnostic technique
Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy.
Airway management in ED - an update
This document summarizes an expert presentation on updates in airway management. It reviews studies comparing direct laryngoscopy to video laryngoscopy, different paralytic agents for rapid sequence intubation, and challenges with gum elastic bougie intubation. It also discusses considerations for prehospital airway management and the potential role of ultrasound in airway assessment. The key takeaways are that video laryngoscopy may help with difficult airways but direct laryngoscopy also has utility, different video laryngoscope designs impact success rates, and ultrasound measurements may predict difficult emergency intubations.
Airway In Trauma
The document discusses various techniques for securing a patient's airway during trauma care including orotracheal intubation, rapid sequence intubation, and cricothyroidotomy. It provides details on indications, contraindications, and proper techniques for different airway management procedures depending on a patient's age, injuries, and other factors. Guidelines are given for assessing difficult airway features, appropriate medications and dosages, and special considerations for pediatric patients.
Dr Shahna airway management in ICU; 2016
This document discusses airway management in critically ill patients in the ICU. It notes that airway management is a fundamental aspect of emergency and critical care medicine, and expertise in airway management is an important skill. Managing airways in critically ill ICU patients presents unique challenges compared to other settings, as the patients often have varying degrees of hypoxemia, hemodynamic instability, comorbidities, and tolerate delays in establishing an airway poorly. Proper preparation, assessment, positioning, pre-oxygenation, drug selection and technique are emphasized to successfully secure the airway while minimizing complications in these high-risk patients.
Airway Management
Tracheal intubation involves inserting a tube into the trachea to control ventilation and oxygenation during anesthesia. Various airway devices and techniques are used for intubation. Complications can occur during or after intubation, and careful patient positioning, preparation of equipment, and confirmation of proper tube placement are important to perform intubation safely.
Intubation Review
Tracheal intubation has several advantages including maintaining airway patency, allowing for controlled ventilation, and providing a route for anesthesia administration. Potential complications include trauma during intubation, improper tube placement, laryngospasm, and post-intubation soreness. Proper preparation of equipment like laryngoscope blades, endotracheal tubes, and ventilation bags is important. The intubation technique involves positioning the patient, using a laryngoscope to visualize the vocal cords, and guiding the tube between the cords while ventilating and monitoring breath sounds.
Airway covid 19
basic airway management in COVID 19 patient in ICU.
WHO guideline for airway management in covid 19.
Awake intubation
This document discusses awake intubation, including:
1. Awake intubation is indicated for patients with anticipated difficult airways to maintain airway patency.
2. Proper preparation includes premedication to alleviate anxiety, dry the airway, and protect against aspiration. Topicalization of the airway with local anesthetics is also important.
3. Nerve blocks like the sphenopalatine and anterior ethmoidal blocks are used to anesthetize the nasal cavity and nasopharynx during nasal awake intubation.
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dr.mekonnen
The document summarizes various types of anesthetic equipment used including:
1) Gas supply and distribution systems such as medical gas cylinders, piping, and oxygen concentrators.
2) Anesthetic work stations which integrate components for anesthesia administration such as machines, vaporizers, ventilators and breathing systems.
3) Airway equipment such as face masks, laryngoscopes, endotracheal tubes, and bite blocks used to secure and maintain the patient's airway.
Endotracheal intubation extubation
This document summarizes the indications, procedures, equipment, and complications related to endotracheal intubation and extubation. It describes the anatomy of the upper airway and indications for intubation such as respiratory failure, airway obstruction, or the need for positive pressure ventilation. The document outlines the procedures and equipment used for oral and nasal intubation, including laryngoscopes, endotracheal tubes, and positioning. Potential complications of intubation and extubation are also summarized such as infection, trauma, aspiration, and laryngeal injury.
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Extubation presentation
This document discusses the criteria and process for extubating a patient from mechanical ventilation. It begins by defining extubation as the removal of the endotracheal tube, which should only be done once a patient no longer requires ventilation and can protect their airway. Specific criteria are provided for assessing a patient's readiness, including hemodynamic stability, adequate oxygenation, normal blood gases, resolution of underlying conditions, and intact neurological function. Potential complications are also reviewed. The process of extubation involves preparing equipment, explaining to the patient, continuously monitoring their condition, and carefully removing the tube while suctioning and assessing airway patency.
Rapid Sequence Intubation
This document discusses rapid sequence intubation (RSI) for airway management in the pre-hospital setting. It outlines the philosophy of RSI, including that it should only be used if absolutely necessary due to risks. The document provides guidance on RSI techniques, medications, equipment, and verification of proper endotracheal tube placement. Several studies are referenced that show risks of RSI including increased mortality rates, hypoxia, and worse outcomes for head injured patients compared to bag-valve-mask ventilation alone. Proper training and only using RSI for prolonged transports are emphasized.
Raj care laryngospasm ppt
Laryngospasm is a protective reflex that causes glottic closure to prevent aspiration. It can impede respiration if sustained. While rare, it is most commonly seen during emergence from anesthesia. Complete laryngospasm with closure of the vocal cords poses risks like hypoxia, while partial laryngospasm can be treated by removing stimuli, positioning, airway maneuvers, sedation or muscle relaxants. Prevention focuses on identifying at-risk patients and using non-irritating anesthesia to minimize stimuli during intubation and extubation.
Airway management in critical care
- Emergency intubations outside the operating room in critically ill patients carry a high risk of failure and adverse events due to patient factors like pulmonary issues and obesity that make preoxygenation less effective.
- Multiple techniques can be used together to optimize preoxygenation and apneic oxygenation, including various positions, CPAP, PEEP, and nasal cannulas to prolong safe apnea time and reduce desaturation risks.
- It is important to have alternative plans prepared in case of intubation difficulties, to get help early, and carefully consider risks and benefits of intubation for any given patient.
Airway solutions in trauma scenarios
1) The patient, a 28-year old man involved in a motorbike accident, has an impaired airway as evidenced by snoring, rapid breathing, and low oxygen saturation.
2) The top priority is securing the patient's airway. Basic airway maneuvers and adjuncts like chin lift, jaw thrust, oropharyngeal airway are appropriate first steps given intact reflexes.
3) If the airway cannot be maintained or there is impending compromise, more invasive techniques like intubation may be needed while protecting the cervical spine. Assessing risk factors can help predict difficult airways requiring specialized equipment or procedures like surgical airway.
Intubation in critical care setting
This document discusses intubation in critical care settings. It notes that ICU intubations carry high risks, with 25% of patients experiencing severe hypoxemia and 60% of airway incidents resulting in death or neurological injury. Difficulties arise from factors relating to the patient, staff, and environment. The MACOCHA score can help predict difficult airways. The Difficult Airway Society guidelines recommend preparation, checklists, backup plans including front-of-neck access, and continuous monitoring after intubation to reduce risks from these high-stakes procedures in critically ill patients.
Difficult airway guidelines paeds
1) The document provides guidelines for managing difficult airways in pediatrics, outlining a 3-step approach including laryngoscopy and intubation, use of a supraglottic airway device, and emergency surgical access if ventilation fails.
2) It discusses the anatomical and physiological differences between children and adults that increase airway management challenges in pediatrics.
3) Adjuvants like video laryngoscopy, passive oxygenation, and ultrasound guidance are reviewed as tools that can help extend the safe apnea time and improve visualization or placement of airway devices in children.
Airway Management
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
1. tracheostomy, Cricothyrotomy, PDT
Tracheostomy is a surgical procedure that creates an opening in the trachea to allow direct access to the breathing tube. It has several indications including bypassing upper airway obstruction, removing secretions from the lungs, and facilitating prolonged mechanical ventilation. There are different types of tracheostomies based on location and whether they are temporary or permanent. Potential complications include bleeding, infection, and tracheal stenosis. Proper care including suctioning, humidification, and dressing changes can help prevent complications. Percutaneous dilational tracheostomy is a minimally invasive technique to perform tracheostomy at the bedside using guidewires and dilation. Decannulation involves gradually removing the tracheostomy tube when the original condition improves
Extubation from Ventilator
The document discusses guidelines for extubation in pediatric patients. It states that a patient should be capable of maintaining an airway and spontaneous ventilation before extubation. It also discusses assessing readiness for extubation and managing potential post-extubation issues like stridor. Precautions should be taken and equipment available to address any complications. An acceptable extubation failure rate is reported to be between 10 to 19 percent.
Bronchoscopy, Diagnostic technique
Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy.
Airway management in ED - an update
This document summarizes an expert presentation on updates in airway management. It reviews studies comparing direct laryngoscopy to video laryngoscopy, different paralytic agents for rapid sequence intubation, and challenges with gum elastic bougie intubation. It also discusses considerations for prehospital airway management and the potential role of ultrasound in airway assessment. The key takeaways are that video laryngoscopy may help with difficult airways but direct laryngoscopy also has utility, different video laryngoscope designs impact success rates, and ultrasound measurements may predict difficult emergency intubations.
Airway In Trauma
The document discusses various techniques for securing a patient's airway during trauma care including orotracheal intubation, rapid sequence intubation, and cricothyroidotomy. It provides details on indications, contraindications, and proper techniques for different airway management procedures depending on a patient's age, injuries, and other factors. Guidelines are given for assessing difficult airway features, appropriate medications and dosages, and special considerations for pediatric patients.
Dr Shahna airway management in ICU; 2016
This document discusses airway management in critically ill patients in the ICU. It notes that airway management is a fundamental aspect of emergency and critical care medicine, and expertise in airway management is an important skill. Managing airways in critically ill ICU patients presents unique challenges compared to other settings, as the patients often have varying degrees of hypoxemia, hemodynamic instability, comorbidities, and tolerate delays in establishing an airway poorly. Proper preparation, assessment, positioning, pre-oxygenation, drug selection and technique are emphasized to successfully secure the airway while minimizing complications in these high-risk patients.
Airway Management
Tracheal intubation involves inserting a tube into the trachea to control ventilation and oxygenation during anesthesia. Various airway devices and techniques are used for intubation. Complications can occur during or after intubation, and careful patient positioning, preparation of equipment, and confirmation of proper tube placement are important to perform intubation safely.
Intubation Review
Tracheal intubation has several advantages including maintaining airway patency, allowing for controlled ventilation, and providing a route for anesthesia administration. Potential complications include trauma during intubation, improper tube placement, laryngospasm, and post-intubation soreness. Proper preparation of equipment like laryngoscope blades, endotracheal tubes, and ventilation bags is important. The intubation technique involves positioning the patient, using a laryngoscope to visualize the vocal cords, and guiding the tube between the cords while ventilating and monitoring breath sounds.
Airway covid 19
basic airway management in COVID 19 patient in ICU.
WHO guideline for airway management in covid 19.
Awake intubation
This document discusses awake intubation, including:
1. Awake intubation is indicated for patients with anticipated difficult airways to maintain airway patency.
2. Proper preparation includes premedication to alleviate anxiety, dry the airway, and protect against aspiration. Topicalization of the airway with local anesthetics is also important.
3. Nerve blocks like the sphenopalatine and anterior ethmoidal blocks are used to anesthetize the nasal cavity and nasopharynx during nasal awake intubation.
Endotracheal Suction(ETS} : Principle and Practice
Covers indications , complications, Preparation , Procedure ,post procedure care and special consideations
dr.mekonnen
The document summarizes various types of anesthetic equipment used including:
1) Gas supply and distribution systems such as medical gas cylinders, piping, and oxygen concentrators.
2) Anesthetic work stations which integrate components for anesthesia administration such as machines, vaporizers, ventilators and breathing systems.
3) Airway equipment such as face masks, laryngoscopes, endotracheal tubes, and bite blocks used to secure and maintain the patient's airway.
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Endotracheal Suction(ETS} : Principle and Practice
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This document summarizes the indications, procedures, equipment, and complications related to endotracheal intubation and extubation. It describes the anatomy of the upper airway and indications for intubation such as respiratory failure, airway obstruction, or the need for positive pressure ventilation. The document outlines the procedures and equipment used for oral and nasal intubation, including laryngoscopes, endotracheal tubes, and positioning. Potential complications of intubation and extubation are also summarized such as infection, trauma, aspiration, and laryngeal injury.
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Corticosteroids are one of the most common medications that are used in the intensive care units (ICUs);
corticosteroids are used for a variety of indications, including septic shock, acute respiratory distress syndrome
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(COPD) exacerbations and many others.
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Stridor and management of obstructed airway
This document discusses various types of noisy breathing and causes of hoarseness and stridor. It describes laryngomalacia as the most common congenital laryngeal anomaly manifesting as inspiratory stridor that is often relieved by prone positioning. For management of obstructed airways, it recommends techniques such as Heimlich maneuver, oropharyngeal/nasal airways, intubation, cricothyroidotomy, tracheostomy based on the level and severity of obstruction. Intubation is preferred over tracheostomy for short term airway issues in children due to easier decannulation and lower risk of subglottic stenosis.
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oxygen administration procedure
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Gas laws in anaesthesia
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Respiratory Failure
Respiratory failure can occur when the lungs cannot properly oxygenate the blood or eliminate carbon dioxide. This can be caused by issues with the lungs, chest wall, respiratory control center or respiratory muscles. Mechanical ventilation and artificial airways like endotracheal tubes or tracheostomies may be needed to support or replace inadequate breathing. Positive pressure ventilators deliver air under pressure through an artificial airway to oxygenate the blood. Nurses monitor patients on ventilators and manage artificial airways.
Principles of icu ventilators
Mechanical ventilators are machines that assist or replace patient breathing. They have several key components, including an input power source, drive mechanism, control circuit, and ability to generate specific output waveforms. Ventilators are classified based on whether they use positive or negative pressure to support breathing. Positive pressure ventilators are now more commonly used and deliver gas by exerting pressure on the airway. They can control ventilation based on parameters like pressure, volume, flow, or time. Modern microprocessor-controlled ventilators provide closed-loop servo control to precisely match patient needs.
Edited ppt
Oxygen therapy involves administering oxygen at concentrations greater than 21% found in air to treat conditions where oxygen levels in the blood are low. It works by increasing oxygen saturation in tissues. Various devices are used including nasal cannulas, face masks, tracheostomy collars, and T-pieces to deliver oxygen concentrations from 24-100% depending on the device. Oxygen therapy treats various respiratory conditions like COPD, heart attacks, and injuries where supplemental oxygen is needed to support tissue function. Side effects from long term high concentration use include cough, nausea, and nasal congestion.
Techniques of oxygen delivery
This document discusses techniques for oxygen delivery in pediatric patients. It describes various low and high flow oxygen delivery systems including masks, nasal cannulas, tents, and endotracheal tubes. Low flow systems like simple masks can deliver 35-60% oxygen while high flow systems like non-rebreathing masks or endotracheal tubes can provide over 90% oxygen concentration. Adjuncts like oropharyngeal and nasopharyngeal airways are also reviewed. The appropriate device is chosen based on the patient's condition and oxygen needs. Proper sizing and technique are emphasized for effective oxygen delivery.
Oxygen delivery devices
This is a PowerPoint presentation about oxygen delivery device, their advantages, disadvantage, and limitation.
Oxygen therapy. methods of oxygenation
this topic is on various methods of oxygenation. includes all the delivery systems as well as the procedure
Nursing Care of Ventilated Patient
this is brief presentation , I had present it in my workfield..hope u get benefit and I will be happy to get new information about my topic,,,,
Oxygen Therapy
Oxygen therapy provides oxygen to patients through various sources and delivery systems. The amount of oxygen delivered is determined by the flow rate measured in liters per minute, which varies by patient condition and method of administration. Common delivery systems include nasal cannulas, face masks, tents, and catheters. Nasal cannulas are inexpensive and comfortable but deliver a lower concentration of 24-45%, while non-rebreather masks deliver the highest concentration of 95-100%. The appropriate delivery system depends on the patient's needs, comfort, and age.
Basic modes of mechanical ventilation
This document discusses various modes of mechanical ventilation. It begins by describing the basic components and functions of a ventilator. The document then explains the key parameters that ventilators can control including tidal volume, frequency, pressure, and time settings. Several common ventilation modes are described including controlled mandatory ventilation (CMV), assist-control ventilation, intermittent mandatory ventilation (IMV), and synchronized intermittent mandatory ventilation (SIMV). Each mode is defined by how the ventilator delivers breaths in terms of being time-triggered or patient-triggered and how breaths are cycled. The advantages and disadvantages of different modes are also briefly discussed.
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The document provides an overview of mechanical ventilation, including indications for intubation and ventilation, principles of mechanical ventilation, patterns of assisted ventilation, ventilator dependence and complications, liberation from mechanical ventilation through weaning, and troubleshooting arterial blood gases. Key topics covered include indications for intubation, objectives of mechanical ventilation, strategies for mechanical ventilation including use of airway pressures and compliance, patterns of assisted ventilation such as assist control ventilation and pressure control ventilation, complications of mechanical ventilation, parameters for bedside weaning, and low volume ventilation strategies for ARDS.
Ventilatory support in special situations balamugesh
This document summarizes ventilation strategies for different clinical situations including ARDS, COPD, asthma, and bronchopleural fistula. It discusses ventilator settings such as tidal volume, PEEP, FiO2 and prone positioning that are recommended for ARDS. Non-invasive ventilation options for COPD and asthma exacerbations are also reviewed. Intubation criteria and strategies to deliver aerosol treatments during mechanical ventilation are provided. Managing air leak through bronchopleural fistula with techniques like differential lung ventilation or chest tube use is outlined.
Ventilation in obstructive airway disease
This document discusses ventilation in obstructive airway diseases. It provides indications and contraindications for non-invasive ventilation (NIV) including criteria such as respiratory rate greater than 25 breaths per minute and moderate to severe respiratory acidosis. NIV can be used to support patients with acute exacerbations of COPD or asthma to reverse respiratory failure. Ventilator settings aim to support gas exchange, reduce work of breathing, and prevent complications. Dynamic hyperinflation can cause auto-PEEP which increases workload and impairs hemodynamics. Settings to treat auto-PEEP include increasing expiratory time, reducing tidal volume, and applying external PEEP.
MECHANICAL VENTILATION-SOME OF THE BASICS.pptx
This document discusses mechanical ventilation, including its history, uses, types, settings, modes, complications, and patient care goals. It provides an overview of mechanical ventilation, describing how it works to mechanically assist or replace spontaneous breathing. Various modes of ventilation are outlined, along with typical settings adjusted based on patient status. Potential complications are listed. Patient goals focus on effective breathing, gas exchange, nutrition, preventing infection or immobility issues. Care includes airway management and monitoring respiratory rate and depth.
mechanical ventilators
Mechanical ventilation involves using a machine to help a person breathe. It can be used to treat conditions that affect breathing. The document discusses mechanical ventilators, how they work, indications for their use, complications, modes of ventilation, and the nurse's role in caring for a patient on a ventilator. It provides details on monitoring the patient, maintaining the ventilator and circuits, positioning, nutrition, and preventing complications.
Mechanical Ventilator Patients.pptx
Mechanical ventilation (MV) works by applying a positive pressure breath and is dependent on the compliance and resistance of the airway system
Basics of Mechanical Ventilation
The document provides information on indications for mechanical ventilation, criteria for instituting ventilation based on pulmonary function and blood gas parameters, settings for mechanical ventilation including tidal volume, respiratory rate, PEEP, and oxygen concentration. It also outlines the basics of various ventilator modes including assist-control, pressure support, and SIMV. Guidelines are provided for initiating mechanical ventilation and troubleshooting issues like high pressures, low volumes, and patient-ventilator dysynchrony. The nurse's key roles in monitoring the patient and equipment are also summarized.
LIBERATION FROM VENTILLATOR.pptx
This document discusses liberation from mechanical ventilation and the criteria for removing a patient from a ventilator. It outlines several key points:
1) Liberation involves gradually withdrawing ventilator support and allowing the patient to breathe spontaneously on their own. Readiness is determined by ventilatory, oxygenation, and other physiological criteria.
2) Weaning can be either abrupt for some patients or more gradual over time for others requiring long-term ventilation support. Successful weaning relies on evaluating factors like respiratory function, gas exchange, and other organ system stability.
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Ventilatory support
The document discusses various topics related to mechanical ventilation including:
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2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
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MECHANICAL VENTILATION.pptx
Mechanical ventilation is a method used to assist or replace spontaneous breathing by using physical devices. It can be used to treat acute respiratory failure, provide prophylactic support, or induce hyperventilation. There are two main types: negative pressure ventilation which applies lower pressure outside the chest and positive pressure ventilation which applies higher pressure inside the lungs. Common ventilator modes include assist control, SIMV, pressure control, and pressure support. Proper monitoring, settings, and care are needed to prevent complications while the patient is ventilated.
Venti
This document provides information on the management of patients on mechanical ventilation. It discusses the indications for mechanical ventilation including inadequate oxygenation and ventilation. It then covers the mechanisms of oxygen transport and various causes of inadequate oxygenation and perfusion. The document outlines the purposes of ventilation and procedures for initiation and settings of mechanical ventilation including modes, parameters, and monitoring of patients. It discusses potential problems during ventilation and goals of ventilation. Finally, the document reviews weaning from mechanical ventilation.
MECHANICAL VENTILATION - A BRIEF DISCUSSION.pptx
This document discusses mechanical ventilation, including its history, uses, types, settings, modes of ventilation, complications, and patient goals and care. It provides an overview of mechanical ventilation, from its use in acute and chronic illness to manage breathing, to different ventilator modes like CMV, ACV, SIMV and PSV. It also covers settings, interfaces, potential complications and how to monitor patients on ventilators.
Mechanical ventlation
Indication
Acute Respiratory Failure
Hypoxemia
Neuromuscular Disorders
Pulmonary edema
Over Sedation
reduce ICP
stabilize the chest wall
Aspiration
ARDS
Pulmonary embolism
Non Invasive Ventilation indications
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
Weaning from mechanical ventilator
This document discusses strategies for liberating patients from mechanical ventilation. It outlines key factors that indicate readiness to wean, including improved respiratory function and organ system stability. Two common approaches to weaning are described: gradual weaning using methods like pressure support ventilation or spontaneous breathing trials followed by extubation if tolerated. Protocols using objective criteria can standardize and expedite the weaning process. Factors that may cause weaning failure include respiratory issues, cardiovascular problems, or infection. Readiness is assessed through measurements of ventilatory drive, muscle strength, and breathing patterns.
Care of patient on ventilator
1. The document provides guidelines for the care of patients requiring mechanical ventilation including indications for ventilation, modes of ventilation, troubleshooting alarms, weaning criteria and processes, and complications.
2. Mechanical ventilation is used to support breathing for those unable to maintain adequate oxygen or CO2 levels spontaneously, including those with respiratory failure, neuromuscular diseases, or trauma/illnesses affecting breathing.
3. Modes of ventilation include controlled, assisted, intermittent mandatory, and pressure support modes. Nurses must monitor for alarms related to pressures, volumes, and apnea and address causes such as tubing issues or secretions.
Mechanical ventilation of bronchial asthma, is it a real dilemma
This document provides guidance on managing a patient with severe asthma exacerbation who requires mechanical ventilation. Key recommendations include:
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2. Monitor plateau pressures to estimate alveolar pressure and avoid excessive pressures (>30 cmH2O) that can cause barotrauma.
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Mechanical Ventilation (1).ppt
This document provides information on mechanical ventilation management. It discusses the goals of airway management and indications for mechanical ventilation. The roles of nurses include monitoring patients on ventilators and notifying respiratory therapists when issues arise. There are two main types of ventilators and settings must be individualized. Modes of ventilation are described along with weaning and extubation processes. Alarms are addressed and their common causes.
Mechanical ventilation
The document discusses various aspects of mechanical ventilation including:
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2) Monitoring pressures such as peak pressure and auto-PEEP is important to avoid complications.
3) Specific considerations for ventilating patients with COPD/asthma include permissive hypercapnia to reduce dynamic hyperinflation and work of breathing.
4) Ventilating ARDS patients should use low tidal volumes, as clinical trials have shown this approach reduces mortality compared to traditional higher volumes.
Critical care units
Critical care units such as intensive care units (ICUs) and critical care units (CCUs) provide specialized intensive care for critically ill patients. There are many different types of ICUs depending on medical specialty, such as neonatal ICUs, cardiac ICUs, and surgical ICUs. ICUs are equipped with mechanical ventilators and extensive monitoring equipment to support vital organ functions. Mechanical ventilation is often required to assist patients who cannot breathe adequately on their own. There are various modes of mechanical ventilation to meet patients' different respiratory needs.
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