Articles: intubation.
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Successful tracheal intubation with the flexible fibreoptic bronchoscope requires a certain amount of skill which is acquired by practice. It has been suggested that the new Bullard laryngoscope may be mastered more easily. ⋯ The Bullard laryngoscope was as easy to master as the flexible fibreoptic device, but passage of the tracheal tube took longer. Both devices require a similar amount of practice.
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A new method to distinguish oesophageal from tracheal intubation using an end-tidal carbon dioxide detector was evaluated. In a prospective study on 50 healthy adult patients, the end-tidal carbon dioxide detector was reliably used to detect initial oesophageal intubation in 22 cases, and then to confirm tracheal intubation in all 50 patients. We conclude from this study that the end-tidal carbon dioxide detector is a reliable, rapid and easy method for the detection of oesophageal intubation.
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The FFB may facilitate airway management and offers utilization in intubation, extubation, diagnosis of airway damage, ET tube changing, and simultaneous diagnosis and therapeutic intervention in UAO. The FFB may also be used to facilitate insertion of a double-lumen EB tube to initiate dual lung ventilation. In addition to development of technical skills, the ICU physician should know the indications and complications of FOB in the critically ill patient.
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Anaesth Intensive Care · Aug 1990
Management of failed endotracheal intubation at caesarean section.
A review of the history of endotracheal intubation and endotracheal tubes is presented and a plan of management of failed endotracheal intubation at caesarean section is described. The importance of preparation for such an event by incorporation of certain features into anaesthesia training programs is emphasised.
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A 64-year old female requiring prolonged ventilatory support was scheduled for an elective tracheostomy. Anesthesia consisted of surgical infiltration of 1% lidocaine and supplemental isoflurane. The patient was mechanically ventilated with an FIO2 of 1.0. ⋯ Proper management of an endotracheal tube fire includes stopping ventilation, disconnecting the oxygen source, removing the endotracheal tube, diagnosing injury, administering short-term steroids, administering antibiotics if indicated, providing ventilation and medical support as necessary and monitoring the patient for at least 24 hours. Extreme caution is necessary when using electrocautery in close proximity to an endotracheal tube. If electrocautery is used in close proximity to an endotracheal tube, an FIO2 of 0.3 or less with helium should be used.