ANESTHESIA AND RESUSCITATION

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HE ABC’S - AIRWAY ❏ # = fracture ❏ most acute airway problems in an unconscious patient can be managed using simple techniques such as: • 100% O2 with the patient in the lateral position (c ... ontraindicated in known suspected C-spine #) • head tilt via extension at the atlanto-occipital joint (contraindicated in known/suspected C-spine #) • jaw thrust via subluxation of temporomandibular joint (TMJ) • suctioning (secretions, vomitus, foreign body) • positioning to prevent aspiration • inserting oro- or naso-pharyngeal airway ❏ nasopharyngeal airway indicated when an oropharyngeal airway is technically difficult (e.g. trismus, mouth trauma) • large adult 8-9 mm, medium adult 7-8 mm, small adult 6-7 mm internal diameter ❏ complications of nasopharyngeal airway include • tube too long - enters the esophagus • laryngospasm • vomiting • injury to nasal mucosa causing bleeding and aspiration of clots into the trachea ❏ oropharyngeal airway holds tongue away from posterior wall of the pharynx • large adult 100 mm, medium adult 90 mm, small adult 80 mm • facilitates suctioning of pharynx • prevents patient from biting and occluding endotracheal tube (ETT) ❏ complications of oropharyngeal airway include • tube too long - may press epiglottis vs. larynx and obstruct • not inserted properly - can push tongue posteriorly ❏ more advanced techniques include • tracheal intubation (orally or nasally) • cricothyroidotomy • tracheostomy TRACHEAL INTUBATION ❏ definition: the insertion of a tube into the trachea either orally or nasally Indications for Intubation - the 5 P's ❏ Patency of airway required • decreased level of consciousness (LOC) • facial injuries • epiglottitis • laryngeal edema, e.g. burns, anaphylaxis ❏ Protect the lungs from aspiration • absent protective reflexes, e.g. coma, cardiac arrest ❏ Positive pressure ventilation • hypoventilation – many etiologies • apnea, e.g. during general anesthesia • during use of muscle relaxants ❏ Pulmonary Toilet (suction of tracheobronchial tree) • for patients unable to clear secretions ❏ Pharmacology also provides route of administration for some drugs Equipment Required for Intubation ❏ bag and mask apparatus (e.g. Laerdal/Ambu) • to deliver O2 and to manually ventilate if necessary • mask sizes/shapes appropriate for patient facial type, age ❏ pharyngeal airways (nasal and oral types available) • to open airway before intubation • oropharyngeal airway prevents patient biting on tube ❏ laryngoscope • used to visualize vocal cords • MacIntosh = curved blade (best for adults) • Magill/Miller = straight blade (best for children) ❏ Trachelight - an option for difficult airways ❏ Fiberoptic scope - for difficult, complicated intubations ❏ Endotracheal tube (ETT): many different types for different indications • inflatable cuff at tracheal end to provide seal which permits positive pressure ventilation and prevents aspiration • no cuff on pediatric ETT (physiological seal at level of cricoid cartilage) • sizes marked according to internal diameter; proper size for adult ETT based on assessment of patient • adult female: 7.0 to 8.0 mm • adult male: 8.0 to 9.0 mm • child (age in years/4) + 4 or size of child's little finger = approximate ETT size • if nasotracheal intubation, ETT 1-2 mm smaller and 5-10 cm longer • should always have ETT smaller than predicted size available in case estimate was inaccurate ❏ malleable stylet should be available; it is inserted in ETT to change angle of tip of ETT, and to facilitate the tip entering the larynx; removed after ETT passes through cords ❏ lubricant and local anaesthetic are optional ❏ Magill forceps used to manipulate ETT tip during nasotracheal intubation ❏ suction, with pharyngeal rigid suction tip (Yankauer) and tracheal suction catheter ❏ syringe to inflate cuff (10 ml) [Show More]

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