Professional Documents
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DEBOJYOTI MUKHERJEE
PGT, ANESTHESIOLOGY
R.G.KAR MCH ; KOLKATA
Resuscitation
A process to restore
consciousness or other signs
of life ofoneapparentlydead
or dying
orwhoserespirations
hadceased.
CARDIO PULMONARY
RESUSCITATION
Cardiopulmonary resuscitation
commonly known as CPR is an
technique of basic life support for
oxygenating the brain and heart until
appropriate definitive medical
treatment can restore spontaneous
blood circulation and breathing with
intact neurological function in a
person who is in cardiac arrest.
Oropharyngeal Airway
Guedel airway
OPA
The oral airway is
inserted with the
curve towards the
side of the mouth
Then rotated 180
degree once past
soft palate so that
the curve of the
airway matches the
curve of the tongue.
helps to ensure the
tongue is not
pushed back during
airway insertion
Nasopharyngeal Airway
Soft plastic or rubber tube that is designed to pass just inferior to
the base of the tongue.
Nasopharyngeal Airway
Sizes range from 17-26 cm in length
and 6-9 mm internal diameter
Measured from tip of the nose to the
corner of the patients ear.
The size of these airways correlates to
the internal diameter (in millimeters)
of the tube and the length, which
increases with the diameter size. Sizes
of 6-7mm are suitable for most adults
NPA
The nasal airway is
lubricated with a water
soluble lubricant
The beveled tip is
inserted directed
towards the septum,
with the airway
directed perpendicular
to the face
If resistance is met,
rotating the airway
may help or the other
nare may be used
Blind insertion
airways considered
an alternative
airway control
device to be used
when intubation is
unsuccessful
They do not require
visualization of the
vocal cords
SAD
Ability to be placed without direct
visualization
Better cardio vascular stability both
during insertion and removal
Minimal IOP and ICP changes
Provide little protection against
aspiration
LMA Positioning
Advancements
New generation LMAs
I gel
Laryngeal Tube/ King LTS/ LTD
Cobra plus tube
3. Combitube
Combi-tube
This is a multi-lumen airway that works
whether it is inserted into the esophagus or
the trachea
It either blocks the esophagus above and
below the glottic opening or by directly
ventilating the trachea
Contraindicated in patients under 5 foot tall
or those under 14 years old, in patients who
have ingested caustic substances, patients
with esophageal trauma or disease, and in
patients with an intact gag reflex
Advanced Airways
Orotracheal Intubation
Nasotracheal Intubation
Digital Intubation
Surgical Airways
Endotracheal tubes
optimal device for airway
management.
A correctly inserted ETT provides a
seal, preventing foreign bodies or
secretions from contaminating the
airway, and enable enables
ventilation directly to the trachea.
> Most commonly made up of
polyvinyl chloride.
PARTS OF ETT
It consists of the
following parts :
BEVELED TIP
MURPHY EYE
CUFF
CONNECTOR
PILOT BALLOON
"armored"
Endotracheal
tubes
stylet
A stylet can be inserted inside an Endotracheal tube to
make it more rigid, or to change the shape of the tube.
For example, the tip of the Endotracheal tube can be
bent slightly to facilitate passage through the cords. It
is recommended that the stylet be used in all
emergency intubations. In this way, if the shape of the
tube needs to be modified, the stylet is already in
place. The stylet should be lubricated prior to insertion
into the Endotracheal tube, so that it is easy to
remove.
Laryngoscope
A laryngoscope is an
instrument used to
examine the larynx and
to facilitate intubation of
the trachea.
The laryngoscope
provides a physical
means to view the glottis
and vocal cords using an
attached illumination
source to improve the
picture for the operator.
PARTS OF LARYNGOSCOPES
The parts of
laryngoscopes
are as follows:
HANDLE
ELECTRICAL
CONTACT
FLANGE
BLADE
BULB
Syringe:
Endotracheal tubes used in adults have an inflatable
cuff near the tip. The cuff, once inflated, is intended
to seal the airway from aspiration of Oropharyngeal
contents, and to prevent air leaks during positive
pressure ventilation. A 10 cc syringe should be
included on the aspiration tray to inflate the cuff of
the tube with 5-10 cc's of air.
Suctions
A portable suction device
should be available as cardiac
arrest can and does occur in
areas where wall-mounted
suction is not available. A rigid,
oral suction device (the
Yankaeur) and a selection of
flexible suction tubes for use
with Endotracheal suction must
be available on the trolley.
Magills forceps
Magills forceps are long-bladed,
curved forceps that a practitioner can
operate with one hand to remove
foreign
objects or assist with swabbing or ET
intubation.
Lubrication:
The tip of the Endotracheal tube should be
lubricated prior to insertion. Lignocaine jelly
is a good lubricant because it reduces
irritation due to its local anesthetic effect.
Tape:
Once in place, the ET tube must be
secured to avoid inadvertent extubation
or migration of the tube down the airway.
It is usually taped in place following
confirmation of correct ET tube position.
Stethoscope:
The position of the ET tube is confirmed by
listening over the lung fields and the epigastrium
with a stethoscope. The worst possible outcome of
an attempt at endotracheal intubation is
unrecognized esophageal intubation. It is
absolutely essential that a stethoscope be used to
confirm tube positioning by listening over both lung
fields and the epigastrium.
Capnomete
r
Capnography
is the measurement of
Nasotracheal Intubation
Can be done blind or with the aid of a
laryngoscope.
If done blind, the patient must be
breathing.
Surgical airways
TRACHEOSTOMY
Cricothyrotomy
cricothyrotomy
temporizing
measure
EQUIPMENTS
FOR
BREATHING
NASAL CANULA
venturi mask
venturi mask, also
known as an airentrainment mask (and
sometimes by the
brand name
Ventimask), is
amedical deviceto
deliver a knownoxygen
concentration to
patients on
controlledoxygen
therapy
Uses Of Manual
resuscitators
During resuscitation and other
critical situation
Transport
Stand by
Out side OT
AMBU
Artificial Mandatory Breathing Unit
Or
Air Mask Bag Unit
Contraindications
BVM ventilation is absolutely contraindicated
in the presence of complete upper airway
obstruction.
BVM ventilation is relatively contraindicated
after paralysis and induction (because of the
increased risk of aspiration).
Positioning
Place towels under the patients head to
position the ear level with the sternal
notch.
Extend the patients head slightly.
Technique
Place the mask on the patients face before attaching the bag. 4
Cover the nose and the mouth with the mask without extending it over the
chin.
Change the size of the mask, as appropriate, to create a good seal.
Hold the mask in place using the one-hand E-C technique, as shown below.
Contd.
Use the non dominant hand.
Create a C-shape with the thumb
and index finger over the top of
the mask and apply gentle
downward pressure.
Alternate one-hand
technique.
Two-hand technique
If a second person is available to provide ventilations by compressing the bag
Ventilation
volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult). 6
Ventilate at a rate of 10-12 breaths per minute. (for a patient with perfusing
rhythm)
During cardiopulmonary resuscitation (CPR), give 2 breaths after each series of
30 chest compressions until an advanced airway is placed. Then ventilate at a
rate of 8-10 breaths per minute.
Give each breath over 1 second.
If the patient has intrinsic respiratory drive, assist the patients breaths. In a
patient with tachypnea, assist every few breaths.
Ventilate with low pressure and low volume to decrease gastric distension.
Cont..
Maintain cricoid pressure consistently .
to compress the esophagus and reduce the risk of aspiration.
However, it does not completely protect against regurgitation,
especially in cases of prolonged ventilation or poor technique. 1
Care must be taken to avoid excessive pressure, which can result
in compression of the trachea.
Pearls
Lift the mandible up to the mask rather than pushing the mask down onto
the face.
An adequate seal can more easily be made with a mask that is too big than
one that is too small.
Leave dentures in place, when possible, to improve mask seal.
If the patient's facial hair makes a seal difficult to obtain, apply a watersoluble lubricant over the beard to improve the contact between the face and
the mask.
If the one-handed mask ventilation is not effective, switch to the two-handed
technique.
Cont..
The best way to prevent aspiration is with good technique,
including low-pressure, low-volume ventilation with slow
insufflation. Newer bags have built-in pressure valves. The green
zone includes pressures up to 20 cm of water and corresponds to
the lowest risk of gastric distention.
Note the type of bag being used. Bags with one-way expiratory
valves allow greater than 90% oxygen delivery during both
positive pressure and spontaneous ventilation, while bags
lacking this feature only deliver about 30% oxygen during
spontaneous breaths.
Complications
Aspiration
Hypoventilation
Hyperventilation
barotrauma
Defibrillation
The waveform of the shock can be mono- or
biphasic.
Defibrillators
Monophasic
Biphasic
Defibrillator types
External
Electrodes
Defibrillation
Precautions:
hqubeilat@ksu.edu.sa
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