Rapid sequence intubation
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RSI involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It has several advantages including increased success rate of intubation, decreased time to intubation, and minimized risks of aspiration, hypoxia, and trauma during the procedure. The document outlines the steps of RSI, including pre-oxygenation, drug administration, protection and positioning of the patient, endotracheal tube placement and verification, post-intubation management, and potential complications. Key aspects are careful preparation and having backup equipment available in case of difficulties.
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Rapid sequence intubation
Rapid sequence intubation involves several key steps:
1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation.
2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration.
3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
Rapid sequence intubation
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
Rapid Sequence Induction & Intubation
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
Microlaryngeal surgery
1. The document discusses tracheostomy and anaesthesia considerations for microlaryngeal surgery. It covers the definition, history, steps of the procedure, complications, types of tubes, and techniques for airway management including endotracheal intubation and jet ventilation.
2. Lasers are commonly used in microlaryngeal surgery and ENT procedures. Safety precautions are required due to the risks of burns, fires and smoke inhalation. Special endotracheal tubes coated in metal foil or other fire-resistant materials help protect the airway during laser use.
3. Careful planning is needed for airway management and ventilation during these delicate procedures to provide optimal surgical conditions while protecting the patient's air
MANAGEMENT OF DIFFICULT AIRWAY
This document discusses the prevalence and management of difficult airways. It notes that difficult intubation occurs in about 1 in 2,000-3,000 routine cases, while cannot intubate cannot ventilate situations arise in about 1 in 5,000-10,000 cases. Key steps in managing a difficult airway include preparing alternate airway devices, having a plan for awake intubation versus general anesthesia, and being prepared for emergency surgical access if needed. The document provides guidance on evaluating the airway, contents for a difficult airway cart, algorithms for management, and follow up care considerations.
Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
The document discusses various supraglottic airway devices including the bougie, tracheal light, laryngeal tube, and combitube.
The bougie is an intubation aid that is inserted through the vocal cords to help guide placement of an endotracheal tube. The tracheal light uses transillumination to help visualize placement of an endotracheal tube in difficult airways. The laryngeal tube is a new supraglottic airway device made of silicone that provides an alternative to endotracheal intubation or laryngeal mask airway placement. The combitube is a double lumen tube that can provide ventilation whether placed in the trachea or esoph
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.
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Rapid sequence intubation
Rapid sequence intubation involves several key steps:
1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation.
2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration.
3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
Rapid sequence intubation
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
Rapid Sequence Induction & Intubation
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
Microlaryngeal surgery
1. The document discusses tracheostomy and anaesthesia considerations for microlaryngeal surgery. It covers the definition, history, steps of the procedure, complications, types of tubes, and techniques for airway management including endotracheal intubation and jet ventilation.
2. Lasers are commonly used in microlaryngeal surgery and ENT procedures. Safety precautions are required due to the risks of burns, fires and smoke inhalation. Special endotracheal tubes coated in metal foil or other fire-resistant materials help protect the airway during laser use.
3. Careful planning is needed for airway management and ventilation during these delicate procedures to provide optimal surgical conditions while protecting the patient's air
MANAGEMENT OF DIFFICULT AIRWAY
This document discusses the prevalence and management of difficult airways. It notes that difficult intubation occurs in about 1 in 2,000-3,000 routine cases, while cannot intubate cannot ventilate situations arise in about 1 in 5,000-10,000 cases. Key steps in managing a difficult airway include preparing alternate airway devices, having a plan for awake intubation versus general anesthesia, and being prepared for emergency surgical access if needed. The document provides guidance on evaluating the airway, contents for a difficult airway cart, algorithms for management, and follow up care considerations.
Bougie, trachlite , laryngeal tube , combitube , i gel ,truview
The document discusses various supraglottic airway devices including the bougie, tracheal light, laryngeal tube, and combitube.
The bougie is an intubation aid that is inserted through the vocal cords to help guide placement of an endotracheal tube. The tracheal light uses transillumination to help visualize placement of an endotracheal tube in difficult airways. The laryngeal tube is a new supraglottic airway device made of silicone that provides an alternative to endotracheal intubation or laryngeal mask airway placement. The combitube is a double lumen tube that can provide ventilation whether placed in the trachea or esoph
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.
Retrograde intubation
1) Retrograde intubation involves inserting a catheter through the cricothyroid membrane and guiding an endotracheal tube into the trachea.
2) It can be used when direct laryngoscopy is not possible due to anatomical issues, secretions, or trauma.
3) The classical technique uses a Tuohy needle and epidural catheter, while the modified technique uses an angiocatheter and guidewire to reduce kinking.
4) Proper positioning, anesthesia, and gentle advancement of the endotracheal tube over the guiding catheter or wire are important for successful retrograde intubation.
Rapid sequence intubation
Rapid sequence intubation (RSI) is a method for quickly securing a patient's airway to prevent aspiration of gastric contents during induction of general anesthesia. It involves pre-oxygenating the patient, administering induction drugs to induce unconsciousness, giving a paralytic to facilitate intubation, and immediately placing an endotracheal tube while applying cricoid pressure. RSI is indicated for patients at high risk of aspiration, such as those with delayed gastric emptying, altered mental status, or a difficult airway. Proper preparation, pre-treatment, paralysis, intubation placement, and post-intubation management are key steps to successfully perform RSI. Complications can include failed intubation,
Endotracheal Tube and Laryngeal Mask Airway
This document discusses endotracheal tubes and laryngeal mask airways. It begins by describing what endotracheal tubes are and their uses in intubation to protect the airway and enable mechanical ventilation. It covers tube types, sizing, intubation procedure, and complications. It then describes laryngeal mask airways as an alternative to intubation for maintaining the airway during anesthesia, noting they are easier to insert but do not provide the same protection from aspiration.
Percutaneous tracheostomy
This document provides information on percutaneous tracheostomy including its history, indications, complications, procedures, and care. It details techniques such as tracheostomy tube insertion and changing, cuff management, suctioning, and stoma site care. Percutaneous tracheostomy is described as a simpler alternative to surgical tracheostomy with benefits such as being performed at the bedside in the ICU.
Aspiration Pneumonia
1) Aspiration pneumonitis is a chemical injury caused by inhalation of sterile gastric contents, while aspiration pneumonia is an infectious process caused by inhalation of oropharyngeal secretions colonized by bacteria.
2) Risk factors for aspiration pneumonia include neurological dysphagia, gastroesophageal reflux, poor oral hygiene, and silent aspiration which is common in stroke patients.
3) Treatment of aspiration pneumonitis includes suctioning the airway after witnessed aspiration and possible intubation. Antibiotics are not routinely recommended but may be used if infection develops. Corticosteroids are not proven to provide clear benefits.
Management of intraoperative bronchospasm
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
Premedication
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
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This document discusses various techniques for endotracheal intubation used in oral and maxillofacial surgery. It begins with an introduction to endotracheal intubation and its historical use before describing different types of intubation like orotracheal, nasotracheal, retrograde, and fiberoptic intubation. It also covers indications, contraindications, necessary equipment, and procedures for intubation. Complications are mentioned and the document concludes with key points about maintaining the airway during maxillofacial surgical procedures.
Bronchospasm ppt
Dr. Imran's document discusses the management of intraoperative bronchospasm. It defines bronchospasm as constriction of the smooth muscles of the bronchi and bronchioles. It then covers the anatomy, innervation, causes, signs and symptoms, diagnosis, pathophysiology, anesthetic agents that can cause it, and treatment of bronchospasm. The treatment involves deepening anesthesia, administering bronchodilators like salbutamol, and other drugs like ipratropium bromide, magnesium sulfate, and hydrocortisone to reverse bronchoconstriction and prevent hypoxia.
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.
LAYNGEAL MASK AIRWAY
This document discusses the laryngeal mask airway (LMA), including its history, design, indications, contraindications, side effects, necessary equipment, proper preparation and placement technique, verification of correct placement, securing, and potential problems. It also describes different types of LMAs such as the flexible, intubating, C-Trach, ProSeal, and classic LMAs.
Lma, laryngospasm and pulmonary edema
This document discusses the Laryngeal Mask Airway (LMA), including its uses, sizes, advantages, and disadvantages compared to other airway devices. It also covers complications associated with the LMA like laryngospasm and negative pressure pulmonary edema. Laryngospasm is described as a protective reflex that can be triggered by light anesthesia or airway irritation. The management of laryngospasm involves securing the airway and administering muscle relaxants if needed. Negative pressure pulmonary edema is discussed as a rare complication of laryngospasm where high negative intrathoracic pressures cause fluid accumulation in the lungs.
Post Burn Contracture Neck
The patient has received an excessive dose of ketamine for her body weight. Ketamine has a long duration of action and she is still experiencing its effects 12 hours later when she should have recovered much sooner. A lower and more appropriate dose of ketamine should have been used.
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This document discusses alternative airway techniques such as retrograde intubation, submental intubation, and others. It begins by defining difficult airway situations and providing anatomical details of the larynx. It then describes the technique of retrograde intubation, involving passing a wire through a needle in the cricothyroid membrane and using it to guide an endotracheal tube. Indications for retrograde intubation include facial anomalies limiting mouth opening. The technique of submental intubation is also summarized, involving creating a submental skin incision and tunnel to guide the endotracheal tube. Applications of these alternative techniques include maxillofacial, dental, and plastic surgeries.Video & fibreoptic laryngoscope
Video laryngoscopy allows clinicians to visualize the larynx indirectly by using a fiberoptic or digital laryngoscope inserted into the nose or mouth, with the images displayed on a monitor. It has several advantages over direct laryngoscopy including improved visualization of the larynx and ability to record procedures. Flexible fiberoptic laryngoscopy uses flexible optical fibers to transmit images from a distal lens and allows for nasal or oral intubation. It is very versatile but requires the patient to be awake. Various techniques can be used to anesthetize the airway for awake flexible fiberoptic intubation including topicalization, nerve blocks, and nebulization.
Difficult airway management
This document provides an overview of difficult airway management in the ICU. It discusses factors that can lead to difficult intubation in ICU patients such as remote location, unstable physiology, and patient factors. It describes different techniques for managing the difficult airway including anticipated difficult airways, unanticipated difficult airways, and cannot intubate/cannot ventilate scenarios. Equipment for difficult airways is outlined including video laryngoscopes, fiberoptic scopes, supraglottic airway devices, and surgical airway options like needle cricothyroidotomy. Pre-oxygenation techniques and adjuncts to improve laryngoscopy views are also summarized.
Bier block (intravenous regional anesthesia)
This presentation details the indications, mechanism, procedure, complications and drugs used for bier block anesthesia.
RSI 2023.pptx
Rapid sequence induction and intubation (RSII) is a technique used to rapidly secure the airway while minimizing the risk of regurgitation and aspiration. It involves pre-oxygenating the patient, intravenously inducing anesthesia, applying cricoid pressure, and swiftly intubating the trachea. While the classic RSI technique included placing a gastric tube, current modified versions often omit this step. Proper patient positioning, drug preparation, equipment readiness, and team coordination are essential to ensure safe and effective RSII.
Monitored anaesthesia care
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
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This document discusses different types of tracheostomy tubes. It begins by outlining the functions of a tracheostomy tube and describes the ideal properties. It then details the parts of a tracheostomy tube and various types including cuffed, uncuffed, fenestrated, sizes for neonates/pediatrics/adults, and tubes with special features. It provides guidance on selecting the appropriate tube based on a patient's needs and anatomy. Tube accessories like speaking valves and occlusion caps are also described.
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Operator:
- Wear appropriate PPE
- Use in-line suction catheter
- Limit passes to ≤3
- Discard safely, decontaminate
Monitor vitals, oxygenation
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Retrograde intubation
1) Retrograde intubation involves inserting a catheter through the cricothyroid membrane and guiding an endotracheal tube into the trachea.
2) It can be used when direct laryngoscopy is not possible due to anatomical issues, secretions, or trauma.
3) The classical technique uses a Tuohy needle and epidural catheter, while the modified technique uses an angiocatheter and guidewire to reduce kinking.
4) Proper positioning, anesthesia, and gentle advancement of the endotracheal tube over the guiding catheter or wire are important for successful retrograde intubation.
Rapid sequence intubation
Rapid sequence intubation (RSI) is a method for quickly securing a patient's airway to prevent aspiration of gastric contents during induction of general anesthesia. It involves pre-oxygenating the patient, administering induction drugs to induce unconsciousness, giving a paralytic to facilitate intubation, and immediately placing an endotracheal tube while applying cricoid pressure. RSI is indicated for patients at high risk of aspiration, such as those with delayed gastric emptying, altered mental status, or a difficult airway. Proper preparation, pre-treatment, paralysis, intubation placement, and post-intubation management are key steps to successfully perform RSI. Complications can include failed intubation,
Endotracheal Tube and Laryngeal Mask Airway
This document discusses endotracheal tubes and laryngeal mask airways. It begins by describing what endotracheal tubes are and their uses in intubation to protect the airway and enable mechanical ventilation. It covers tube types, sizing, intubation procedure, and complications. It then describes laryngeal mask airways as an alternative to intubation for maintaining the airway during anesthesia, noting they are easier to insert but do not provide the same protection from aspiration.
Percutaneous tracheostomy
This document provides information on percutaneous tracheostomy including its history, indications, complications, procedures, and care. It details techniques such as tracheostomy tube insertion and changing, cuff management, suctioning, and stoma site care. Percutaneous tracheostomy is described as a simpler alternative to surgical tracheostomy with benefits such as being performed at the bedside in the ICU.
Aspiration Pneumonia
1) Aspiration pneumonitis is a chemical injury caused by inhalation of sterile gastric contents, while aspiration pneumonia is an infectious process caused by inhalation of oropharyngeal secretions colonized by bacteria.
2) Risk factors for aspiration pneumonia include neurological dysphagia, gastroesophageal reflux, poor oral hygiene, and silent aspiration which is common in stroke patients.
3) Treatment of aspiration pneumonitis includes suctioning the airway after witnessed aspiration and possible intubation. Antibiotics are not routinely recommended but may be used if infection develops. Corticosteroids are not proven to provide clear benefits.
Management of intraoperative bronchospasm
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
Premedication
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
Endotracheal intubation in oral & maxillofacial surgery
This document discusses various techniques for endotracheal intubation used in oral and maxillofacial surgery. It begins with an introduction to endotracheal intubation and its historical use before describing different types of intubation like orotracheal, nasotracheal, retrograde, and fiberoptic intubation. It also covers indications, contraindications, necessary equipment, and procedures for intubation. Complications are mentioned and the document concludes with key points about maintaining the airway during maxillofacial surgical procedures.
Bronchospasm ppt
Dr. Imran's document discusses the management of intraoperative bronchospasm. It defines bronchospasm as constriction of the smooth muscles of the bronchi and bronchioles. It then covers the anatomy, innervation, causes, signs and symptoms, diagnosis, pathophysiology, anesthetic agents that can cause it, and treatment of bronchospasm. The treatment involves deepening anesthesia, administering bronchodilators like salbutamol, and other drugs like ipratropium bromide, magnesium sulfate, and hydrocortisone to reverse bronchoconstriction and prevent hypoxia.
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.
LAYNGEAL MASK AIRWAY
This document discusses the laryngeal mask airway (LMA), including its history, design, indications, contraindications, side effects, necessary equipment, proper preparation and placement technique, verification of correct placement, securing, and potential problems. It also describes different types of LMAs such as the flexible, intubating, C-Trach, ProSeal, and classic LMAs.
Lma, laryngospasm and pulmonary edema
This document discusses the Laryngeal Mask Airway (LMA), including its uses, sizes, advantages, and disadvantages compared to other airway devices. It also covers complications associated with the LMA like laryngospasm and negative pressure pulmonary edema. Laryngospasm is described as a protective reflex that can be triggered by light anesthesia or airway irritation. The management of laryngospasm involves securing the airway and administering muscle relaxants if needed. Negative pressure pulmonary edema is discussed as a rare complication of laryngospasm where high negative intrathoracic pressures cause fluid accumulation in the lungs.
Post Burn Contracture Neck
The patient has received an excessive dose of ketamine for her body weight. Ketamine has a long duration of action and she is still experiencing its effects 12 hours later when she should have recovered much sooner. A lower and more appropriate dose of ketamine should have been used.
Alternative technique of intubation retromolar, retrograde, submental and oth...
Alternative technique of intubation retromolar, retrograde, submental and oth...Dhritiman Chakrabarti
This document discusses alternative airway techniques such as retrograde intubation, submental intubation, and others. It begins by defining difficult airway situations and providing anatomical details of the larynx. It then describes the technique of retrograde intubation, involving passing a wire through a needle in the cricothyroid membrane and using it to guide an endotracheal tube. Indications for retrograde intubation include facial anomalies limiting mouth opening. The technique of submental intubation is also summarized, involving creating a submental skin incision and tunnel to guide the endotracheal tube. Applications of these alternative techniques include maxillofacial, dental, and plastic surgeries.Video & fibreoptic laryngoscope
Video laryngoscopy allows clinicians to visualize the larynx indirectly by using a fiberoptic or digital laryngoscope inserted into the nose or mouth, with the images displayed on a monitor. It has several advantages over direct laryngoscopy including improved visualization of the larynx and ability to record procedures. Flexible fiberoptic laryngoscopy uses flexible optical fibers to transmit images from a distal lens and allows for nasal or oral intubation. It is very versatile but requires the patient to be awake. Various techniques can be used to anesthetize the airway for awake flexible fiberoptic intubation including topicalization, nerve blocks, and nebulization.
Difficult airway management
This document provides an overview of difficult airway management in the ICU. It discusses factors that can lead to difficult intubation in ICU patients such as remote location, unstable physiology, and patient factors. It describes different techniques for managing the difficult airway including anticipated difficult airways, unanticipated difficult airways, and cannot intubate/cannot ventilate scenarios. Equipment for difficult airways is outlined including video laryngoscopes, fiberoptic scopes, supraglottic airway devices, and surgical airway options like needle cricothyroidotomy. Pre-oxygenation techniques and adjuncts to improve laryngoscopy views are also summarized.
Bier block (intravenous regional anesthesia)
This presentation details the indications, mechanism, procedure, complications and drugs used for bier block anesthesia.
RSI 2023.pptx
Rapid sequence induction and intubation (RSII) is a technique used to rapidly secure the airway while minimizing the risk of regurgitation and aspiration. It involves pre-oxygenating the patient, intravenously inducing anesthesia, applying cricoid pressure, and swiftly intubating the trachea. While the classic RSI technique included placing a gastric tube, current modified versions often omit this step. Proper patient positioning, drug preparation, equipment readiness, and team coordination are essential to ensure safe and effective RSII.
Monitored anaesthesia care
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
Tracheostomy tubes by Dr.Ashwin Menon
This document discusses different types of tracheostomy tubes. It begins by outlining the functions of a tracheostomy tube and describes the ideal properties. It then details the parts of a tracheostomy tube and various types including cuffed, uncuffed, fenestrated, sizes for neonates/pediatrics/adults, and tubes with special features. It provides guidance on selecting the appropriate tube based on a patient's needs and anatomy. Tube accessories like speaking valves and occlusion caps are also described.
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Endotracheal intubation in oral & maxillofacial surgery
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Similar to Rapid sequence intubation
Care of patients on mechanical ventilator covid 19
- Hold the ET tube securely
- Pass the suction catheter gently
- Limit suctioning to ≤10 sec
- Use lowest possible suction pressure
Operator:
- Wear appropriate PPE
- Use in-line suction catheter
- Limit passes to ≤3
- Discard safely, decontaminate
Monitor vitals, oxygenation
Cannot intubate
The document discusses guidelines for managing a failed tracheal intubation, including multiple attempts at intubation with different laryngoscopes and guides, insertion of a supraglotic airway device if intubation fails, rescue face mask ventilation, and emergency cricothyroidotomy as a last resort if ventilation and oxygenation cannot be maintained by other means. It emphasizes having the proper equipment available, training and experience in difficult airway management techniques, and documenting airway issues that occur.
Rapid sequence intubation
Dr. Md Imtiaz Hossain Bhuiyan HDU DOCTOR| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh Mobile +8801324-404020| Mail: Imtiaz.Bhuiyan@iqarus.com
Emergency Airway Management 2014: Mark P. Brady PA-C
This document provides an overview of pediatric airway management and ventilation. It discusses key differences between adult and pediatric airways, important equipment, approaches to difficult airways including rapid sequence intubation and surgical airways, post-intubation management, and the management of crashing asthmatics. Key points emphasized include having a plan for all scenarios, being prepared with the proper equipment, and tailoring care specifically to pediatric patients when their anatomy and physiology differ from adults.
Airway management in special scenarios
1) Airway management is challenging in patients with cervical spine injuries or trauma due to the risk of worsening spinal injuries during intubation attempts. 2) Manual in-line stabilization is the preferred technique for intubating these patients to minimize head and neck movement, but it can impair the laryngoscopic view and increase intubation difficulties. 3) Awake fiberoptic intubation allows for intubation without cervical spine movement but requires patient cooperation. Overall the goal is to secure the airway while preventing further cervical spine injury.
Safe apnea time - by Jason Greenman MD
This topic is so important in airway management that #NoDesat has become a trending meme on Twitter. You can be an average intubator, but a master oxygenator and you and your patient will likely be fine. On the other hand, if you’re a great intubator but poor at oxygenation you will face tough times when encountering an unexpected difficulty during intubation.
Rapid sequence intubation
Rapid sequence intubation (RSI) is a technique that is used when rapid control of the airway is needed as a precaution for patients that may have a 'full stomach' or other risks of pulmonary aspiration. A short description about RSI procedure according to IQARUS guideline.
Dr. Ummay Sumaiya
ICU DOCTOR
| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh |
Mail: Ummay.Sumaiya@iqarus.com
Rapid Sequence Intubation.pptx
Rapid sequence intubation (RSI) involves administering sedatives and paralytics to quickly sedate and paralyze a patient to facilitate emergency intubation. It aims to minimize risks of aspiration, trauma, and hypoxia. Proper preparation, pre-oxygenation, pretreatment, paralysis, protection with cricoid pressure, intubation, and post-intubation management are the "seven P's" of RSI. Indications include those at high risk of aspiration. Etomidate or ketamine are commonly used sedatives depending on the patient's condition. Succinylcholine or rocuronium are often used as paralytics. Cricoid pressure protects
rapidsequenceintubation-160123162517.pdf
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are outlined. Specific induction agents, paralytics, and reversal drugs are also discussed.
Intubation & RSI.pptx
This document discusses endotracheal intubation. It begins by describing airway anatomy and then covers indications, contraindications, and preparation for rapid sequence intubation. The seven Ps of rapid sequence intubation are outlined. Preparation, equipment, patient positioning, laryngoscopy technique, tube placement confirmation, and post-intubation management are described in detail. Complications are briefly mentioned. Alternative intubation techniques like delayed sequence intubation and awake oral intubation are also summarized.
Critical illness airway management
This document discusses airway management in critical illness. It emphasizes the importance of thorough preparation, optimization of patient physiology, careful equipment selection, effective team communication and consideration of backup plans. Key steps include comprehensive airway assessment, positioning, preoxygenation, hemodynamic support and ensuring adequate monitoring and assistance are available. Difficulties that may arise include hypoxemia, hypotension, failed intubation or inability to oxygenate the patient. Strategies like use of supraglottic airways or surgical airway are discussed for such scenarios. Overall, a methodical approach with a focus on patient safety is recommended for managing critically ill patients requiring intubation.
Rapid sequence intubation in ED
Rapid sequence intubation (RSI) involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It allows for increased success rates, decreased intubation times, and reduced risks of aspiration, hypoxia, and trauma. The key steps of RSI are preparation, preoxygenation, pretreatment, paralysis with induction, positioning, placement with proof of tube position, and post-intubation management. Confirmation of tube placement involves clinical assessment and mechanical methods like end-tidal CO2 monitoring and ultrasound. Complications can be minimized by adhering to the standardized RSI protocol.
Airway management in trauma victims
The document discusses airway management in trauma patients, noting that trauma poses risks for cervical spine injury which complicates airway management, and outlines strategies for assessing and securing the airway through simple, definitive, or semi-definitive means depending on the situation, with endotracheal intubation, surgical airway, or supraglottic devices as options. Rapid sequence intubation may be conducted but requires strict protocols and backup plans to address potential complications or failed intubation. The document emphasizes the importance of cervical spine immobilization in trauma patients until injury can be ruled out to avoid further spinal cord damage.
airway management.pptx
This document provides an overview of airway management. It begins by defining airway management and listing its key objectives. It then discusses clinical features of airway obstruction, respiratory arrest, and basic airway maneuvers like head-tilt/chin-lift. It also covers basic airway adjuncts like oropharyngeal airways and nasopharyngeal airways. Finally, it introduces advanced airway devices like laryngeal mask airways and describes how to size them appropriately.
Airway Management [Autosaved].pdf
This document discusses airway management. It covers anatomy of the airway, assessment of the airway, equipment for airway management, patient positioning, preoxygenation, bag mask ventilation, endotracheal intubation, use of other airway devices, and difficult airway management. The key steps of routine airway management include pre-anesthetic airway assessment, preparation and equipment check, patient positioning, preoxygenation, bag mask ventilation, and confirmation of proper tube placement.
Microlaryngeal surgery.pptx
This document discusses anesthesia considerations for microlaryngeal surgery. Key points include:
- Ensuring adequate ventilation, oxygenation, and an immobile surgical field while minimizing secretions and reflexes.
- Careful pre-op assessment of the airway and tumor size. Avoiding sedatives if obstruction is present.
- Intra-op monitoring including ECG, BP, pulse oximetry and ETCO2. Induction with short acting drugs and local anesthesia of the vocal cords. Maintenance with oxygen and inhalational agents.
- Ventilation options include controlled ventilation via tracheal tube or alternative techniques like jet ventilation which carries higher risk of barotrauma.
vdocuments.mx_airway-management-56ecf37df3080.ppt
This document discusses various airway management techniques and equipment. It covers indications for intubation, advantages and disadvantages of different airway devices, identification of difficult airways, and equipment for managing difficult airways. Key points include types of endotracheal tubes, methods for confirming tube placement, securing tubes, suctioning, and managing secretions. Difficult airway equipment like LMAs, Combitubes, bougies, and fiberoptic scopes are also reviewed.
Updated Rsi 01242017 dl2
This document outlines procedures for intubation in patients with compromised airways. It indicates that intubation is appropriate for patients in respiratory arrest, with head injuries, who are combative, have altered mental status, hypoxia, seizures, or status asthmaticus. Contraindications include conditions making intubation difficult. Preparation includes assessing the airway, positioning the patient, pre-oxygenating, and administering medications before inducing paralysis and intubating. Placement must be confirmed and the airway secured before providing ongoing care and transport.
Tracheal sugeries
This document discusses tracheal intubation and rapid sequence intubation (RSI). RSI involves rapidly sedating and paralyzing a patient to facilitate endotracheal intubation. The key steps of RSI are preoxygenation, induction with sedatives, paralysis with neuromuscular blocking agents, protection of the airway with cricoid pressure during intubation, confirmation of proper endotracheal tube placement, and post-intubation management and securing of the airway. RSI aims to minimize risks of aspiration and facilitate safe and rapid intubation in emergency situations.
Airway management in maxillofacial trauma
Maxillofacial trauma can cause airway obstruction through several mechanisms such as soft tissue swelling, hematoma formation, or displaced bone fragments. Early assessment and securing of the airway is critical in trauma patients. Initial airway management may involve basic maneuvers like chin lift or placement of an oral/nasal airway. Definitive airway control with endotracheal intubation or surgical airway is indicated if obstruction persists or the patient has decreased mental status. Cervical spine immobilization using manual in-line stabilization is important during airway procedures due to the risk of cervical spine injury with maxillofacial trauma. Awake fiberoptic intubation is preferred if possible to minimize movement, but rapid sequence
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Rapid sequence intubation
- 1. Dr Swarup Das Apprentice of DEM (2nd Batch)
- 2. RSI is simultaneous administration of an induction & neuromuscular blocking agent to facilitate tracheal intubation. Advantage: RSI particularly useful in the pt with an intact GAG Reflex a “Full Stomach” & a life threating injury or illness requring immediate airway manegment. Increased success rate. Decreased time to intubation. Minimizes trauma during laryngoscopy Minimizes hypoxia and hypercapnia Minimizes risk of aspiration Better C –Spine Control Minimizes hemodynamic effects of intubation
- 3. Absolute: Cardiopulmonary arrest present/imminent Operator inexperience Distorted Facial & Airway Anatomy Relative: Anticipated technical difficulties with laryngoscopy and/or intubation
- 4. Plan & Preparation Pre oxygenation Pretreatment Paralysis with induction Protection and positioning Placement with proof Post intubation management TIME ZERO t – 10 minutes t + 90 seconds
- 5. RSI Best approach? Evaluate Airway – LEMON Primary & Backup Method !! PREPARATION Equipment for RSI Laryngoscope handle Laryngoscope blade – Mac 3, Mac 4 (curved blades) Miller 4 (straight) Magill forceps Stylet ETT securing device ETT tubes in various sizes Water soluble lubricant Xylocaine spray 10 cc syringe Assorted size of oral or nasopharyngeal airways Suction equipment including yaunker and suction catheters Bag-valve-mask ETCo2 monitoring device or esophageal intubation detecting device (EDD)
- 6. NITROGEN WASH-OUT OXYGEN WASH-IN pO2 LUNGS pO2 BLOOD pO2 TISSUES Pre-oxygenate the patient with 100%O2 for 3-5 min. by placing the BVM over the patient’s face, creating a tight seal and allowing the patient to breathe on their own. This will wash out nitrogen and establish an oxygen reservoir. This reservoir will allow for several minutes of apnea without arterial desaturation. BVM ventilation should only be provided if the patient’s SpO2 falls below 90%. .
- 7. LOAD L idocaine optional O piates optional A tropine still mandatory for kids < 8 D efasciculating optional (if succinylcholine planned)
- 8. Paralysis with Induction Agent INDUCTION AGENTS Etomidate Thiopental Ketamine Propafol Midazolam PARALYTIC AGENTS DEPOLARIZING Succinylcholine NON-DEPOLARIZING Vecuronium Rocuronium +
- 9. This phase of RSI refers to protecting the airway against aspiration prior to placement of the endotracheal tube by avoiding bag-mask ventilation and applying cricoid pressure (Sellick's maneuver). Positioning…. Ensure bed is at appropriate height for person intubating. Patient should be positioned as close to the head of the bed as possible. Sniffing position: head extension, neck flexion ( suspected case: Jaw Thurst) Protection & Positioning
- 10. After paralysis has been achieved finally the tube is placed through glottis and cuff is inflated. PROOF/ VERIFICATION (verify correct tube placement using both clinical exam and mechanical testing) PLACEMENT WITH PROOF Clinical Verification Visualize placement of tube through cords Lung auscultation (bilateral breath sounds) Abdomen auscultation (no gastric sounds with bagging) Clinical improvement Tube condensation (not reliable) Mechanical Verification Pulse oximetry End tidal CO2 detection Esophageal detector device
- 11. RSI remains incomplete until the properly placed endotracheal tube is secured . SecureSeveral techniques: taping, tying etc Sedative Ongoing Paralysis Agent Indicated? NG/OG Vent Settings Maintaing Cuff Pressure (20-30 cm of H2O) CXR Hypotension can occur due to decreased venous return from increased intrathoracic pressure due to mechanical ventilation or due to sedatives