Articles: intubation.
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Endotracheal intubation by emergency medical services (EMS) personnel in the prehospital setting decreases morbidity and helps to improve the outcome of critically ill patients, especially those with cardiac or respiratory arrest, multiple injuries, or severe head trauma. The endotracheal tube facilitates better oxygenation and ventilation because it enhances lung inflation and protects the lungs from aspiration. ⋯ Compared to physicians in general, properly instructed, well-supervised paramedics can be trained to perform this procedure safely and more efficiently in the emergency setting. The use of the endotracheal tube in the prehospital setting should be strongly encouraged and the training of EMS personnel in this skill should be given high priority.
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Critical care medicine · Oct 1985
Early extubation after surgical repair of congenital heart disease.
Of 220 pediatric patients recovering from surgical repair of congenital heart disease, 147 (67%) met our criteria for early extubation and were extubated either in the operating room or within 6 h after admission to the surgical ICU. The duration of postoperative mechanical ventilation correlated with the duration of cardiopulmonary bypass during surgical repair. In patients undergoing repair of ventricular septal defect, preoperative measures of pulmonary vascular status (PPA/PAO and RP/RS) also correlated with the duration of mechanical ventilation.
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A method of tracheal intubation facilitated by using a transtracheal guide-wire is illustrated by three selected case stories. In two cases, the patients were blindly intubated and in the third case, with epiglottitis, the aditus layngis could be identified only by use of the guidewire. Using a laryngoscope and Magill's forceps, intubation was in this case performed without complications. It is suggested that the method applied in cases of difficult intubation may reduce the rate of acute tracheostomies.