Category: Fundamentals In addition to the ubiquitous sinus tachycardia, a number of dysrhythmias have been reported after intubation. They are primarily ventricular in origin and include ectopic beats, bigeminy and short runs of ventricular tachycardia.
Category: Fundamentals The steps in performing rapid-sequence intubation are often described by the six “P's”: preparation, preoxygenation, pretreatment, paralysis and induction, placement of the tube and postintubation management.
Category: Fundamentals Digital intubation uses the index and middle fingers to blindly direct the endotracheal tube into the larynx. It is particularly well suited to the prehospital situation, such as when a trapped victim cannot be positioned for intubation.
Category: Fundamentals Flexible endoscopic intubation is a common technique anesthesiologists use for known difficult airways. Physicians who perform endoscopic intubations daily have a success rate of nearly 100% when using this technique for difficult intubations.
Category: Fundamentals There is some evidence that cricoid pressure helps prevent gastric inflation during bag-mask ventilation, though cricoid pressure during bag-mask ventilation reduces tidal volume, increases peak inspiratory pressure and prevents good air exchange.
Category: Fundamentals The laryngeal mask airways are widely considered to be essential adjuncts for rescue ventilation and difficult intubation, can be inserted in less than 30 seconds, and provide effective ventilation in more than 98% of patients.
Category: Fundamentals The laryngeal mask airway consists of a hollow shaft or airway tube connected to an oval inflatable masklike cuff designed to sit in the hypopharynx facing the glottis, with the tip at the esophageal inlet.
Category: Fundamentals Extraglottic airway devices can be blindly placed above or posterior to the larynx to allow rapid ventilation and oxygenation. They are good rescue devices for patients who are difficult or impossible to ventilate and oxygenate with a face mask.
Category: Fundamentals The goal of bag-mask ventilation is to achieve adequate gas exchange while keeping peak airway pressure low. Squeezing the bag forcefully creates high peak airway pressure and is more likely to inflate the stomach.
Category: Fundamentals Achieving adequate ventilation with a bag-mask device requires an open upper airway and a good mask seal. Overly aggressive bag-mask ventilation causes stomach inflation and increases the risk for aspiration.
Category: Fundamentals The only contraindication to attempting bag-mask ventilation is when the application is impossible. It is often impossible to achieve an effective face mask seal on patients with deforming facial trauma and those with thick beards.
Category: Fundamentals In patients receiving high concentrations of supplemental O2, nitrogen in the alveoli is replaced by O2. If O2 is absorbed into the blood faster than it is replaced, the volume of the alveoli will decrease and absorptive atelectasis can occur.
Category: Fundamentals Preoxygenation prior to endotracheal intubation is one of the most important aspects of emergency airway management. The goal of preoxygenation is to replace all nitrogen in the lungs with oxygen.
