This document discusses various medical procedures including endotracheal intubation, central line placement, needle decompression, and intraosseous access. It covers indications, contraindications, techniques, complications, and emphasizes the importance of understanding each procedure well, having alternatives if the initial attempt fails, and ensuring patient safety after completion.

2. You should understand well about… Indication Contraindication Step & techniques After care Complication : to be aware of Options !! If the procedure FAIL !

3. Preparation Procedure Step Skill Patient After finish procedure Fail to check & Secure patient . Other factors Rush/stress step

6. “ Patients do not die from a "failure to intubate." 'They die either from failure to stop trying to intubate or from undiagnosed esophageal intubation.” Scott, DB Endotracheal intubation: friend or foe Br Med J (Clin Res Ed). 1986 Jan 18;292(6514):157-8.

19. Indication : Inability to maintain airway with less invasive techniques . mostly : in case difficult airway , try ETT first with preparation for surgical airway by side. Contraindication : Airway can be managed by less invasive method. Others : Partial / complete transection of airway  preferred tracheostomy Not suitable in case with significant injury of Cricoid. Relative Contraindication : Known case of laryngeal pathology (tumor , fracture)  prepare to extend to High tracheostomy. Special considerations : Children : < 8-10 yrs. : Needle cricothyroidotomy only. Bad positioning : not extend neck.

20. Techniques : Traditional surgical cricothyroidotomy Alternative surgical cricothyroidotomy Needle cricothyroidotomy

22. Identify landmark Incision : transverse not more than 2-3 cm.  Anterior Jugular v. Longitudinal only when : neck swelling , suspected High Tracheostomy need.

23. Not deeper than 1.5-2cm.

30. Internal jugular vein Subclavian vein Peripherally Inserted Central Catheter : PICC Femoral vein Peripheral venous cut down

31. Seldinger Catheter over the needle

34. Rt. IJ 15 Rt. SC 18 Lt. IJ 18 Lt. SC 20

35. Scalenus anterior

37. Action tips 1.Prep skin For IJ , prep extend to SC 2. Prep cathetor Flush with Saline 3. Locate vein with finder needle IJ ~ 3 cm. 4. Remove finder needle Cap lock !! 5. Insert introducer needle Traction skin for fix landmark 6. Remove syringe : air embolism Don’t remove hand at all. 7.Insert guidewire Guide dislodge inside pt. or other damage with force. 8. Stop guidewire at 10 cm + skin mark Or when you see ectopy ! Heard arrhythmia. 9. Never let go of the guidewire. 10. Verify tip In SVC not in RA , above azygous v. an d carina. With tip parallel to vessel wall.

39. Humerus Distal tibia : malleolus

41. Cook Jamshidi Illinois Bone injection gun EZ IO

42. Needle decompression for tension pneumothorax And Go-on ICD Landmark : = 2 nd ICS mid clavicular line

43. Pleural space must be identified. Obese patient : Semiupright , beware of diaphragm perforation. ICD with Trocar can cause significant injury not measurement the chest tube  last lumen is too closed to skin.  leakage & subcut.emphysema.

44. You should understand well about… Indication Contraindication Step & techniques After care Complication : to be aware of Options !! If the procedure FAIL !

45. Question ?