The document discusses upper airway obstruction including its anatomy, causes, clinical presentation, and management. It begins with describing the anatomy and physiology of the upper airway from the nose to the larynx. Upper airway obstruction is defined as an obstruction at or above the vocal cords, which can be functional, mechanical, or due to infections. Common causes include tumors, infections like epiglottitis, and trauma. Signs may include respiratory distress, stridor, and dysphagia. Management involves assessing the airway, providing basic support with maneuvers or airway devices, and performing advanced techniques like direct laryngoscopy or tracheostomy if needed.
airway management in trauma patients can be particularly challenging because of the presence of difficult airway and disrupted anatomy.
Anatomical implications, airway assessment in trauma, airway management, helpful airway devices were all mentioned in this presentation.
airway management in trauma patients can be particularly challenging because of the presence of difficult airway and disrupted anatomy.
Anatomical implications, airway assessment in trauma, airway management, helpful airway devices were all mentioned in this presentation.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
How to Give Better Lectures: Some Tips for Doctors
Upper airway obstruction.pptx
1. ADAMA HOSPITAL MEDICAL COLLEGE
DEPARTMENT OF SURGERY
Seminar on
Upper airway obstruction Tracheostomy indication and care
By C1 students
1.Tayachew Desalegn
2.Tita Tegegne
3.Tewodros Alemu
Moderator: Shimelis Zewdie (MD, Surgeon)
September 24, 2021 GC ,Adama.
UAO 1
2. Outline
• Anatomy and physiology of upper airway
• Upper airway obstruction
o Definition
o Cause
o Clinical presentation
• Airway management
o Basic
o Advanced
• Tracheostomy
o Definition
o Indication & care
• Reference 2
UAO
3. Objectives
• At the end of this presentation;
o Describe anatomy & physiology of respiratory system
o Explain upper airway obstruction
o Identify causes of upper airway obstruction
o Mention appropriate management of UAO
o Provide a definition of a tracheostomy
o Identify the indications and complications of a
Tracheostomy 3
UAO
4. Introduction
• The term Respiration can be:
1.Ventilation of the lungs (breathing),
2.The exchange of gases between air and blood
3.The use of oxygen in cellular metabolism.
4
UAO
6. Structurally
A. Upper respiratory tract
B. Lower respiratory tract
Functions
1. Gas exchange
2. Regulation of blood pH.
3. Voice production
4. Olfaction
5.Protection
6
UAO
7. Upper airway
• It is the air conducting passage that extends from
the nose or mouth to the trachea.
• Part;
o Nasal cavity
o Pharynx
o Larynx
o Trachea
UAO 7
8. Nose
• It is a means of entrance to the respiratory
system
Functions
• sense of smell,
• filters inspired air,
• produces sounds and
• excretes water and heat.
8
UAO
9. Nasal Cavity
• Large space that extends from nostrils to
choanae.
Function
• Increase the surface area
• Make skull lighter
• Increase the resonance of sound
9
UAO
10. Pharynx
• Tube that extends from the base of the
skull to 6th cervical vertebra
• Forms the upper part of the
respiratory and digestive passages
• Inferiorly connected to;
– respiratory system at the larynx
– digestive system at the esophagus
10
UAO
11. • The pharynx is divided into three regions:
o Nasopharynx
o Oropharynx
o Laryngopharynx
11
UAO
12. Nasopharynx
• Extends from the choanae to the soft palate
• lies anterior to the first cervical vertebra
• The adenoids in Waldeyer`s ring are situated
• It undergoes physiological hypertrophy during
early childhood
• Eustachian tubes is a common site for the
development of nasopharyngeal carcinoma
12
UAO
13. Oropharynx
• Space between the soft palate and root of the tongue
• Common passage of air, food, and drink
• It is bounded:
o Soft palate------- superiorly
o epiglottis--------- inferiorly
o Fauces pillars ----anteriorly
• Palatine and lingual tonsils are located between the
anterior and posterior pillars of the fauces. 13
UAO
14. Laryngopharynx
• Begins at the level of the hyoid bone
• Extends to cricoid cartilage and
• Ends to;
o Larynx -------------anteriorly
o Esophagus-------- posteriorly
• Innervation
o glossopharyngeal (IX),
o vagus (X)
o Hypoglossal (XII) nerves.
• Damage causes dysphagia and/or aspiration.
14
UAO
15. Larynx
• Connects laryngopharynx with trachea.
• It lies in the midline of the neck anterior
to C4–C6.
• the main function of the larynx is
protection of the tracheobronchial airway
and lungs.
• The wall is composed of nine pieces of
cartilage
o Three paired
o Three single 15
UAO
17. Nerve supply
• Sensory nerve supply
– above the vocal folds is from the superior
laryngeal nerve
– below the vocal folds is from the recurrent
laryngeal nerve.
– Both these nerves are branches of the vagus
nerve (X).
• Motor nerve supply
– recurrent laryngeal nerve, which supplies all
intrinsic muscles.
• Damage to this nerve will cause paralysis of the
vocal fold on the side of the damage.
UAO 17
18. Trachea
• Trachea lies in midline of the neck
extending from cricoid cartilage (C6)
superiorly to the tracheal bifurcation
at the level of sternal angle (T5).
• Comprises 16-20 C shaped cartilage
rings.
• Length 10-12cm.
• Diameter 15-20mm.
UAO 18
19. Upper Airway Obstruction
Definition
• Obstruction of the portion of the airways located
above the thoracic inlet.
• It is an obstruction at or above vocal cord
characterized by inspiratory stridor.
• The oropharynx is the most common site of
upper airway obstruction
19
UAO
20. Etiology
• Upper airway obstruction may be
o Functional
o Mechanical
o Infections
o Burns
20
UAO
21. Functional causes
• CNS depression
• Peripheral nervous system and neuromuscular
abnormalities
• Recurrent laryngeal nerve interruption
• Hypocalcaemia
• Paralysis of vocal cord or vocal fold
21
UAO
22. Mechanical causes
• Tumors of nose and sinuses
• Enlarged adenoid
• Tumors of nasopharynx
• Laryngotracheal trauma
• Foreign body aspiration
22
UAO
24. Clinical Signs and Symptoms
• Respiratory distress
• Altered voice
• Dysphagia
• The hand-to-the-throat choking sign
• Stridor
• Facial swelling
• Prominence of neck veins
• Absence of air entry into the chest, and
• Tachycardia.
24
UAO
25. Investigations
• Full blood count
• Blood Group and cross match
• Direct and indirect laryngoscopy
• Imaging
26. Investigations…
Direct laryngoscopy
• Both diagnostic and therapeutic
• Remove or suction
o Foreign bodies
o Blood
o Vomitus and secretions
• Endotracheal intubation
26
27. Indirect Laryngoscopy
• Ideal for small mouth opening
• Minimizes cervical spine movement
• UAO
o Angioedema
o Retropharyngeal or Laryngeal masses and other
glottic pathology
o Facial deformity or trauma
• Both diagnosis and management of UAO
28. Indirect Laryngoscopy
• Awake
o Predicted inability to ventilate by mask
o UAO
• Asleep
o Failed intubation
o Minimal cervical spine movement
• Oral
o Facial /skull injuries
• Nasal
o Poor mouth opening
28
29. Advantages
• Directly see upper airway and make an accurate
diagnosis
• Spontaneously breathing and awake patient
• If care is taken it is atraumatic and should not
worsen obstruction
• Definitive airway control can be achieved at
conclusion of examination by tracheal intubation.
29
30. Disadvantages
• Need for a skilled operator, cooperative patient
• Difficult in presence of blood and secretions
• Necessity for good local analgesia
• Difficult in the emergency setting
• Traumatic
30
31. Bronchoscopy
• Rigid bronchoscope - can be used in the emergency setting to
secure the airway by carefully passing it through the stenotic
segment.
• Flexible bronchoscopy - can be used to establish the
Diagnosis as well management
31
32. Disadvantages
• Necessity for good local analgesia
• Often difficult in the emergency setting
• General anaesthesia with the resultant risk that
spontaneous breathing and airway control is
completely lost
• Traumatic procedure and may lead to worsened
bleeding and edema.
32
33. Plain Chest & Neck Radiographs
• May be useful as screening test
o Tracheal deviation
o Extrinsic compression
o Radiopaque foreign bodies
• Lateral plain neck radiographs
o Retropharyngeal mass
o Epiglottitis
• Lateral view should be obtained during inspiration with
the neck fully extended
33
34. Computed Tomography
• High spatial and contrast resolution
• Stable patient or unstable patient with an already
secured airway
• Can help identify
o Intrinsic and extrinsic tumors or compressive airway
lesions
o vascular structures
o foreign bodies
• Degree and extension of airway compromise
• Status of the airway lumen
34
35. MRI
• Preferred in imaging of trachea in infants and
young children
• Good resolution without contrast
• Evaluation of mediastinal content
• Has been used to image the UAW
• Use in obstruction is unproved
35
36. Spirometery
• Often used in elective setting
• Used in gradual and mild symptoms of UAO
• The location and functional severity of the obstruction
• Relatively insensitive
• No role in the Management of a patient with ARD
36
38. Examination of the patient
• Quick History & Physical Examination
o Separate severe symptoms and less severe
symptoms
o Start management simultaneously with the
diagnostic process
39. Examination..
• ABC of life
• Observe
o Sign of obstruction
o Skin color
• Listen
o Wheeze , snore
• Feel
o Air entry
43. Basic Airway …
• Removing foreign bodies
o Encouraging the victim to cough
o Back blows
o Chest thrust
o Back slaps
o Heimlich maneuver
o Finger sweep techniques
o Removing with forceps
43
48. Advanced airway management
• Can be performed blindly or by using a
laryngoscope
• Relies on the use of equipments
1. Orotracheal tube
oLMA
oEndotracheal tube
2. Nasotracheal tube
3. Surgical airway
48
49. 1.Orotracheal tubes
• Laryngeal mask airway
o wide-bore airway with an inflatable cuff at the distal
o An alternative to ventilation through mask or TT
o Inserted into the patients pharynx and mask is inflated
o Forms a seal in the pharynx around the laryngeal inlet
o Partially protects larynx from pharyngeal secretions
50.
51. Orotracheal…
• Endotracheal intubation
o Securing an airway by passing an endotracheal
tube via the oro- or nasotracheal route.
o The intubated patient is unable to speak, or
swallow
o It requires a degree of sedation
o Very uncomfortable in an awake patient
51
54. Indication
• Protect airway
o Airway obstruction
Hematoma or facial bleeding
soft tissue swelling
o patient with altered mental status
• Secretion clearance and prevent aspiration
• Mechanical ventilation
• Receiving general anesthesia
• Surgery involving or adjacent to the airway
56. Relative
o Penetrating injuries to the neck and an expanding hematoma
o Evidence of chemical or thermal injury to the mouth, nares, or
hypopharynx
o Extensive subcutaneous air in the neck
o Airway bleeding
57. Nasotracheal Intubation
• Indication
o Trismus
o severe mandibular
injuries
o Obstructing mass in oral
cavity
o Faciomaxillary surgery
• Contraindications
oCoagulopathy
oSevere intranasal
pathology
oFracture of skull
base
58. Extubation
• Muscle relaxant fully reversed
• Patient awake & responsive, stable vital signs
• 100% oxygen at high flow 2-3 min
• Remove secretion in trachea or pharynx
• Turn patient to lateral position
• Deflate cuff and remove ETT
• Continue 100% oxygen by facemask
• In semiconscious patient can provoke
laryngospasm
58
60. Complication…
2. With tube in situ
oAccidental extubation
oEndobronchial intubation
oTube malfunction
oBronchospasm
oAspiration
oSinusitis
60
61. Complication…
3. After extubation
o Hypoxia
o Laryngospasm
o Pulmonary edema
o Stridor
o Hoarsness and sore throat
o VC paralysis
o Granuloma of cords
o Laryngeal or tracheal Stenosis
61
62. Surgical airway management
• Endotracheal intubation is not possible
• Unstable cervical spine is
• Expected difficult intubation
• Includes
Surgical and needle Cricothyroidectomy
Transtracheal jet ventilation
Tracheostomy
62
63. Cricothyroidectomy
• Placing a tube through an incision in the
cricothyroid membrane
• Oxygenation and ventilation
• Extremely effective in the emergency situation
• Requiring little equipment and surgical expertise
• Patient can be ventilated for up to 24–48 hr
• It should be converted to a formal Tracheostomy
63
64. Cricothyroidectomy…
• INDICATIONS
o Emergency airway is required
Massive hemorrhage
Profound emesis
Trismus
Obstructing lesions
Eg.tumor, polyp
Traumatic and congenital deformities
o Orotracheal or nasotracheal intubation is either
unsuccessful and clinician cant intubate and cannot
ventilate the patient
64
66. Cricothyroidotomy …
• Palpate
o Thyroid notch
o Cricothyroid interval
o Sternal notch for orientation
• Transverse skin incision over the cricothyroid
membrane
• Incise through the membrane transversely
• Insert hemostat or tracheal spreader into the incision
and rotate it 90 degrees to open the airway
• Insert a proper-size, cuffed endotracheal tube or
tracheostomy tube
• Direct the tube distally into the trachea
66
67.
68.
69.
70. Contraindications
• No absolute contraindications to emergency
cricothyrotomy
• Relative contraindications
o Possible or known transection of the trachea
o laryngotracheal disruption with retraction of the
distal trachea into the mediastinum
o Fractured larynx
70
71. Complications of Surgical cricothyrodotmy
• Early complications
o Bleeding
o Aspiration
o Laceration of the thyroid cartilage, cricoid cartilage, or tracheal
rings
o Perforation of the posterior trachea
o Unintentional tracheostomy
o Passage of the tube into an extratracheal location
71
72. Complication
• Late complications
o Creation of false passage into the tissue
o Subglottic stenosis (edema)
o Laryngeal stenosis
o Hemorrhage or hematoma formation
o Vocal cord paralysis or hoarseness
o Infection
72
75. Tracheostomy
• It is an operative procedure that creates a surgical
airway in the cervical trachea.
• A procedure done to relief airway obstruction or to
protect the air way by a direct entrance into the
trachea through the skin of the neck.
75
UAO
76. FUNCTION
• Alternative pathway for breathing
• It bypasses the obstruction.
• Improves alveolar ventilation.
• Delivery of anesthesia
• remove tracheobronchial secretion
UAO 76
81. Contraindications
• Laryngeal carcinoma
• Uncorrectable bleeding diathesis
• Gross distortion of neck due to hematoma
• extensive Infection of soft tissues of the neck
• Cervical spine instability
• Obese and short necked
81
UAO
83. Emergency tracheostomy
• A vertical midline skin
incision is made from
the inferior aspect of
the thyroid cartilage
to the suprasternal
notch and continued
down between the
infrahyoid muscles.
• vertical incision
83
UAO
92. Tracheostomy Advantages
• Anatomical dead space is reduced ( by ~50%)
• Increase patient mobility and comfort
• The airway is protected
• Improved airway suctioning
• Improved communication & nutritional support.
Reduce work of breathing and increase alveolar
ventilation
92
UAO
93. Disadvantage
• Loss of heat and moisture exchange mechanism.
• Desiccation of tracheal epithelium.
• loss of ciliated cell and metaplasia.
• stimulates mucus production.
• splinting of the larynx.
93
UAO
94. Risk factors for complications
• Age: infants and adults over 75
• Obesity
• Smoking
• Poor nutrition
• Alcoholism
• Chronic illness
• Diabetes
94
UAO
95. Complications
1. Intraoperative complications
• Haemorrhage (anterior jugular veins)
• Injury to paratracheal structures
• Damage to the trachea and larynx
• Air embolism
• Apnea
• Cardiac arrest(sudden shift acidosis-alkalosis)
95
UAO
98. Percutaneous Tracheostomy
• Tracheostomy performed percutaneously with
bronchoscopic assistance
• A transverse incision is made between the
first and second tracheal rings
• A 22-gauge needle is inserted between the
second and third tracheal rings
UAO 98
99. Cont…
Advantages
• performed at the patient’s bedside.
• Significant bleeding is rare.
• post procedural infections are almost nonexistent
• Lesser cost.
99
UAO
101. • Monitoring vital sign
• Check symmetry of chest expansion
• Auscultate breath sounds
101
Immediately After Intubation
UAO
102. Cont…
Three major factors must be considered
in the care of the tracheostomy patient:
A. Humidification
B. Mobilization of secretions
C. Airway patency.
102
UAO
103. A. Humidification
• The nasopharynx has been bypassed by tracheostomy.
• It is absolutely essential that adequate humidity be
provided to keep the airway moist.
103
UAO
104. • Frequent turning, encouragement of deep
breathing, and ambulation are important in the
prevention of pulmonary complications.
• Regular chest physiotherapy and postural drainage
are both very effective in the mobilization of
secretions
104
B. Mobilization of Secretions
UAO
105. • All patients who are on tracheostomy tube need
suctioning and follow up.
• Suctioning of the tracheostomy tube is necessary
to remove mucus, secretions & maintain a patent
airway.
• pressure setting for tracheal suctioning is 80-
120mmHg (10-16kpa)
105
C. Airway patency
UAO
106. • Special and frequent suctioning care should be given
for those.
o signs of respiratory distress
o Suspicion of a blocked or partially blocked tube
o Inability by the child to clear secretions by coughing
o Desaturation on pulse oximetry
106
UAO
107. Tracheostomy Decannulation
• is a permanent removal of the tracheostomy tube
after weaning from mechanical ventilation
• Occluded using a decannulation cap and
• Child is observed for any signs of increased
respiratory effort or respiratory distress before
removal
107
UAO
108. Patients who fulfill all the following criteria
• No upper airway obstruction.
• The ability to clear secretions that are neither too
copious nor too thick.
• No aspiration during swallowing
• The presence of an effective cough.
108
UAO
109. References
• Bailey & Loves: short practice of surgery ,26th
edition
• Principles of Human Anatomy ,Gerard
J.Tortora,12th edition
• Schwartz's principles of surgery,10th edition
109
The principal structures of the respiratory system are the nose, pharynx, larynx, trachea, bronchi, and lungs .
Ducts from the paranasal sinuses and the nasolacrimal ducts open into the nasal cavity
fauces, the opening of the oral cavity into the pharynx.
Phonation/speech
The larynx functions by closing the vocal fold against the air
being exhaled from the lungs, but the rise in subglottic pressure
forces the vocal folds apart slightly for an instant of time,
resulting in an accompanying sinusoidal wave-like vibration
of the vocal fold epithelium. The opening and closing occurs
in rapid sequence to produce a vibrating column of air, which
is the source of sound that can be articulated by the structure
of the oral cavity to produce speech.
Paralysis or disease of the vocal folds or closely associated
laryngeal structures will give rise to disturbance of the sound,
producing hoarseness.
inspection and palpation of the neck to assess the laryngotracheal anatomy in the individual patient
Allows ventilation for periods in excess of 1 hour providing time for intubation
Cricothyroid membrane is located
14- or 16-gauge plastic sheathed intravascular needle
Directed downwards and backwards into the tracheal lumen
Needle is advanced steadily
Negative pressure is placed on the syringe until bubbles of air are clearly seen
The needle is removed and the plastic sheath cannula remains in the tracheal lumen
Ventilation may be undertaken in a controlled manner
and must be carefully held and fixed in place by the operator so that it does not come out of the lumen into the soft tissues of the neck.
with a jetting device with the chest being observed for appropriate movements.
lies in the median plane and inferiorly it is displaced to the right by the aortic arch.
Its right relationships are the brachiocephalic artery, the right vagus, and the azygos arch.
To the left are the left common carotid and left subclavian arteries, left vagus, and left recurrent laryngeal nerve between the trachea and the mediastinal pleura
The lymph nodes are found in the 3 bifurcation angles of the trachea. They drain into the right lymphatic duct and the thoracic duct
If the situation is one of extreme urgency, a further vertical incision straight into the trachea at the level of the second, third
and fourth ring should be made immediately without regard to the presence of the thyroid isthmus.
In patients who have sufferedsevere head and neck trauma and who may have an unstable cervical spine fracture, cricothyroidotomy may be moresuitable. If it is possible, the patient should be laid supinewith padding placed under the shoulders and the extendedneck kept as steady as possible in the midline. This aidspalpation of the thyroid and cricoid cartilage between thethumb and index finger of the free hand.
Following induction of general anaesthesia and endotracheal intubation, the patient is positioned with a combination of head extension and placement of an appropriatesandbag under the shoulders (Figure 47.34). There shouldbe no rotation of the head. Children’s heads should not beoverextended, as it is possible to enter the trachea in the fifthand sixth rings in these circumstances. A transverse incisionmay be used in the elective situation
Under fiber optic control
1.Outer cannula=main tube
2.Inner cannula=removable & cleared tube
3.cuff= provide ppv (inflated or deflated),prevent risk of aspiration
4.Pilot ballon= external balloon connected internal cuff
5.flange=support main tube structure (secure or suture)
6. Introducer/obturator – A bevel tipped shaft, which is placed inside the outer cannula of the tube during tube insertion. It provides a smooth rounded dilating tip, which will reduce the trauma of tube insertion
7. Fenestrations=permit airflow through these holes, to speak and cough more effectively
8. 15mm adaptor =to allow attachment to ventilation equipment
2. Anatomical dead space – made up of the conducting air passagesThere is consequently significantly reduced airway resistance and increasedalveolar ventilation [alveolar ventilation tidal volume - dead spacevolume]
However, there are several disadvantages:
• Loss of heat and moisture exchange performed in the upper respiratory tract.
• Desiccation of tracheal epithelium, loss of ciliated cells and metaplasia.
• The presence of a foreign body in the trachea stimulates mucous production; where no cilia are present, this mucociliary stream is arrested.
• The increased mucus is more viscid and thick crusts may form and block the tube.
• Although many patients with a tracheostomy can feed satisfactorily, there is some splinting of the larynx, which may prevent normal swallowing and lead to aspiration; this aspiration may not be apparent.
Postoperative treatment is designed to counteract these effects and frequent suction and humidification are most important.
The most dramatic complication involving the tracheostomy is a tracheoinnominate artery fistula (TIAF). 9,10 These fistulas rarely occur (0.3%), but when present, carry a 50 to 80% mortality rate. TIAFs can occur as quickly as 2 days after tracheostomy, but also as late as 2 months postprocedure. The prototypical patient at risk for a TIAF is a thin woman with a long, gracile neck. The patient may have a sentinel bleed, which occurs in 50% of TIAF cases, followed by a most spectacular bleed. Should a sentinel bleed be suspected, the patient should be transported immediately to the operating room for fiberoptic evaluation
Tracheocutaneous fistula
Tracheo-oesophageal fistula
tracheoinnominate artery fistula with severe haemorrhage
Tracheal stenosi
Reason for the tracheostomy resolved. Patient alert, responsive and consenting. Patient tolerating cuff deflation for a minimum of 12 h. Patient managing to protect their airway and have a clear chest. Patient maintaining oxygen saturations. Patient tolerating the use of a speaking valve and/or digital occlusion. Patient able to expectorate around the tube into their mouth. Tracheostomy tube type and size is appropriate.
Hypergranulation of a tracheostomy stoma can cause the followingcomplications: Narrowing of the stoma and tract resulting in difficulty/trauma whenchanging the tracheostomy tube. Bleeding with movement of the tube and tube changes. Impede the healing of the stoma following decannulation.
there are no delays often associated with
scheduling a surgical procedure.
The air is aspirated into the syringe, the guidewire is introduced. After the guidewire is protected, dilators are introduced. All dilators are inserted in a sequential manner from small to large diameter. The tracheotomy tube is then introduced along the dilator and guidewire. The guidewire and dilator are removed, the cuff of the tracheotomy tube is inflated, and the breathing circuit is connected. The endotracheal tube can then be removed.
a. Destruction of cilia and damage to mucous glandsb. Disorganisation and flattening of pseudostratified columnarepithelium and cuboidal epitheliumc. Disorganisation of basement membraned. Cytoplasmic and nuclear degeneratione. Desquamation of cellsf. Mucosal ulcerationg. Reactive hyperaemia following damage