Surgery Seminar NG/OG Tube Placement
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| Hypercapnia | CO2 levels high, symptomatic Hypercapnia is an indication for intubation. COPD, emphysema, asthma
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| Indications for Intubation | Sx hypercapnia, sx hypoxemia, airway protection against aspiration: comatose, neuro insult, overdose; general anesthesia, need to control and remove secretions --pulmonary toilet
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| Contraindications (relative) of Intubation | Awake patient, airway can be managed less invasively, severe airway trauma and obstruction --cricothyrotomy indicated, Cervical Spine injury. Don't forget RA
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| The Gold Standard of airway management | endotracheal intubation
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| LEMON law | Look externally, Evaluate the 3-3-2 rule, Mallampati score, Obstruction?, Neck Mobility
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| Class IV Mallampati Grade | Can't see airway. Class I, best visualization
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| Cormack-Lehane grades what? | View of Glottic Opening. Grade 1&2 have low failure rates. Grade 3&4 have high failure rates
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| Miller | Straight Laryngoscope blade
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| Mac | Curved Laryngoscope blade
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| Laryngoscope blade size for adults | 3-0, or 4-0
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| Preoxygenation | Recommended for 5 minutes in controlled settings
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| Placement of patient for intubation | place patient in "sniffing" position -- align axis. Hyperextended neck.
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| what must you see to intubate? | the glottic opening
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| CO2 is acidic and should turn litmus paper (?) | Purple. Yellow means good ventilation
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| Tip of ETT Should be above | the Carina, don't want to be in the right mainstem.
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| Prolonged intubation attempts | can have hypotension, arrhythmias, vocal cord avulsion
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| Nasotracheal intubation may be useful in some situations: | Possibly spinal injury, clenched teeth, fractured jaw, oral surgery, airway swelling, obesity, arthritic preventing sniffing position
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| Contraindications to Nasotracheal tube | apneic patient, severe midface fractures or suspicision of basilar skull fx, coagulopathy (b/c nose if very vascular)
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| ideal patient position for Nasotracheal tube | Sitting and breathing patient
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| ET tube size range | .5-1
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| is a stylet used in the placement of a Nasotracheal tube? | no
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| How should insertion of Nasotracheal tube be timed? | Time brething and advance at beginning of inspiration. Expect patient to cough with placement
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| BAAM device can be used when? | In placement of Nasotracheal tube
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| Pediatric Airway characteristics | smaller, flexible, tongue is proportionately larger, epiglottis is floppy and round, glottic opening higher and anterior, vocal cords slant upward and closer to base of tongue, narrowest part is cricoid cartilage
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Created by:
ltm12