1- for supporting ventilation in patient with some pathologic disease as:- : upper airway...
TRANSCRIPT
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1- For supporting ventilation in patien t with some pathologic disease as-:
: U pper airway obstruction
: Respi rat ory failure : L oss of con
ciousness
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2- For supporting ventilatio n during general anesthesia
Type of surgery
: Operative site near the airway
: Abdominal or th oracic surgery
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: Prone or lateral position
: Long period of surgery
Patient has risk of p ulmonary aspiration Difficult mask ventilation
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ANATOMY OF AIRWAY
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--- : Congenital anomalies > Pie rre Robin syndrome , Down’s s
yndrome -- : Infection in airway > Retrop
haryngeal abscess, Epiglottitis
: Tumor in oral cavity or larynx
1 ) Condition that associated with difficult intubation
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: Enlarge thyr oid gland
trachea shift to lateral or c
ompressed tr acheal lumen
1) Condition that associated withddddddddd dddddddddd (con’t)
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: Maxillofacial ,cervical or laryngea l trauma
: Temperomandibular joint dysfunction
: Burn scar at face and neck
: Morbidly obese or pregnancy
1) Condition that associated withddddddddd dddddddddd (con’t)
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2) - Interincisor gap : normal > more than3 cms
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Soft palate
Uvula
3) Mallampati classification: Class 3,4 -> may be difficult intubation
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Laryngoscopic view
grade 3,4 -> risk for difficult intubation
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4) Thyromental distance : more tha n5 cms
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6) Flexion and extension of neck
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7) Movement of temperomandib ular joint (TMJ)
Grinding
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1) Laryngoscope : handle and blade
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Macintosh (curved) and Miller (straight)blade
Adult : Macintosh blade, small children : Miller blade
dddddd ddddd
Macintosh blade
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2) Endotracheal tube
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1) Size of endotracheal tube : indddddd dddd dddd ddd d
Male: ID 8.0 mms . Female : ID 7.5 mms New born - 3 months : ID 3.0 mms 3-9 months : ID 3.5 mms 9-18 months : ID 4.0 mms 2- 6 yrs : ID = (Age/3) + 3.5 > 6 yrs : ID = (Age/4) + 4.5
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3) Endotracheal tube cuff
High volume Low pressure cuff
Low volume High pressure cuff
2) Material : Red rubber or PVC
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4) Bevel 5) Murphy’s eye
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6) Depth of endotracheal tube : Midtrachea or below vocal cord ~ 2
cms Adult -> Male = 23 cms ,Female = 21
cms Children Oral endotracheal tube = (Age/2) +
12 (cm) Nasal endotracheal tube = (Age/2) +
15 (cm)
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7) dddd d ddddddd
A. Z-79B. Disposible (Do not reuse)C. Oral/ NasalD. Radiopaque marker
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3.1 Stylet
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4) Oropharyngeal or nasopharyngeal airway
Oral airway Nasal airway
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5) Suction catheter 6) Slip joint
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6) dddd d ddd ddd dddd ddddddddd ddd
7) Magill forcep
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8) Syringe9) Lubricating jelly10) Plaster for strap endotracheal tube4. Monitoring success of endotracheal intubation4.1) Stethoscope4.2) Endtidal - CO2 4.3) Pulse oximeter
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Flexion at lower cervicalspine
-Extension at atlanto occi pital joint
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Vareculla
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Advantage 1) Comfortable for prolong int
ubation in postoperative period
2) Suitable for oral surgery : to nsillectomy , mandible surgery
3 ) For blind nasal intubation 4) Can take oral feeding 5) Resist for kinking and difficu
dd dd dddddddddd dddddddddd
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1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong i
ddddddddd 3) Risk for bacteremia 4) Smaller diameter than oral
-d ddddddddd ddd ddddddd>
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1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess
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1) During intubation :Traumato l i p,tongue or teeth : Hypertension and tachycardi
a or arrhythmia : Pulmonary aspiration : Laryngospasm : Bronchospasm
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1) During intubation : Laryngeal edema : A - rytenoid dislocation > h
oarseness : Increased intracranial pre
ssure : Spinal cord trauma in cer
vical spine injury : Esophageal intubation
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: Obstruction from klinking , secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit
2) During remained intubation
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2) During remained intubation
: Pulmonary aspiration : Lip or nasal ulcer in case with p
rolong period of intubation : Sinusitis or otitis in case with p
rolong nasoendotracheal intubation
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3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway
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4) After extubation
Sore throat Hoarseness Tracheal
stenosis (Prolong intubation)
Laryngeal granuloma