Articles: intubation.
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The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. Although there is a finite number of pieces and types of equipment, pharmacologic adjuncts, and manual techniques, the last two components are variable. ⋯ We believe that the commonly used airway management algorithms are a poor substitute for a conceptual understanding of the basic principles of the five components of airway management, although these decision trees may be useful as learning tools. The construction of a truly complete decision tree is virtually impossible because of the high number of individual patient profiles.
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A historical review of the development of endotracheal intubation is made. Clinical and some X-ray features, allowing to prognosticate the difficult intubation are searched for. Classifications are suggested of the possible reasons for difficulties. ⋯ It is a stress moment both for the patient and for the anesthesiologist. The signs through which the anesthesiologist may determine the position of the tube and rule out eventual esophageal intubation are systematized. Percentages are given on the relative incidence of difficult intubations and fiber optic intubations [correction of fibrointubations] in the different aspects of operative surgery.
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Critical care medicine · Jan 1990
Correct positioning of an endotracheal tube using a flexible lighted stylet.
Endotracheal intubation is not without complications, among the most serious of these being misplacement of the endotracheal (ET) tube. Unrecognized esophageal placement is a lethal complication, but even when placed in the trachea, ET tubes can be displaced distally and enter a mainstem bronchus. Correct positioning of an ET tube is usually defined as the placement of the tube within the trachea approximately 5 cm above the carina. ⋯ A chest x-ray was taken and the distance of the tube tip from the carina was calculated. In each case the tube tip could be placed consistently at a level 5 +/- 1 cm from the carina by observing the maximal transilluminated glow at the sternal notch. We conclude that transillumination of the neck using a flexible lighted stylet can accurately and consistently position an ET tube at an appropriate distance above the carina.(ABSTRACT TRUNCATED AT 250 WORDS)
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The Grieshaber Air System was designed to maintain intraocular pressure during ophthalmologic surgery. It also has been used to maintain pressure in leaking endotracheal tube cuffs. It is a very useful device, especially if the intubation is difficult or the patient's position precludes replacement of the endotracheal tube. Two patients are presented in whom the system was used to maintain endotracheal tube cuff pressure.
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The problems associated with "difficult airways" have almost subsided since the introduction of flexible fiberoptic bronchoscopes for tracheal intubation. Limitations of this technique persist with uncooperative patients, children and infants. ⋯ The device makes intubation possible with all sizes of fiberoptic bronchoscopes. The prerequisites for application of this technique include an airway that will be maintained by mask ventilation.