Articles: intubation.
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For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. ⋯ On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed.
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Double-lumen endotracheal tubes have revolutionized the anesthetic management of patients undergoing thoracic surgery. As experience with the techniques of DLT placement and monitoring progress, an increasing number of uses in the intensive care unit will evolve. ⋯ Isolation of the lungs to prevent contralateral spread of hemoptysis is occasionally of assistance. Frequent monitoring of DLT position while understanding the physiology of differential lung ventilation will minimize complications with these tubes.
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The human larynx is complex and serves multiple functions. Unfortunately, endotracheal tubes do not reproduce all these functions. They serve well as air passages but cannot do so without damaging the mucosa of the posterior larynx. ⋯ It is hoped that this reduction in complications will carry over into the chronic care setting as such monitoring becomes the standard after intubations. Compared with malposition of the tube, most of the other complications of intubation are minor. However, knowledge of the various complications can ensure avoidance of many and early detection and correction of others.
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Intensive care nursing · Sep 1991
ReviewA review of communication with intubated patients and those with tracheostomies within an intensive care environment.
A major aspect of nursing care within intensive care environments is communication. If nursing communication with patients is to be both effective and therapeutic nurses need to understand the principles of communication and identify the purposes of nurse-patient interactions. The main purpose of this article is to review and examine normal communication channels and the actual and potential barriers to communication between nurses and patients who are intubated or have tracheostomies. The assessment of these patients' needs for communication, planning, implementation and evaluation of nursing to meet them are discussed, and also implications for the future.
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Emerg. Med. Clin. North Am. · Aug 1991
ReviewRapid sequence anesthesia induction and advanced airway management in pediatric patients.
A rapid controlled induction of anesthesia is useful to facilitate emergency intubation and to reduce the complications of intubation in pediatric patients. A protocol for rapid sequence intubation and suggestions for optimizing airway management in the Emergency Department are described. The use of end tidal carbon dioxide monitoring and pulse oximetry are strongly advocated to monitor all intubations in the Emergency Department.