Friday, May 16, 2008
Wednesday, May 14, 2008
Difficult intubation in a case of ankylosing spondylitis: a case report.
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1998;volume=44;issue=2;spage=43;epage=6;aulast=Kamarkar --- Difficult intubation in a case of ankylosing spondylitis: a case report
Friday, May 9, 2008
Tracheal Intubation –Pediatric Protocol
The pediatric airway is particularly challenging due to the small patient size, differences in anatomy, and relatively high oxygen demand in pediatric patients. In addition, respiratory compromise is the most common antecedent event prior to a cardiorespiratory arrest. Prompt, proper management of the airway is essential in management of a critically ill pediatric patient.
Indications
1. Unconscious patient with no gag reflex requiring airway protection.
Suggested Tracheal Tube Sizes and Depth
Procedure
1. Perform patient assessment and record vital signs, level of consciousness, and
oxygen saturation.
2. Assess that patient meets criteria for this protocol.
3. Ensure there are no contraindications to use of this protocol.
4. Initiate basic life support treatment measures, including supplemental oxygen.
- these take precedence over management using this protocol
5. Ensure cervical spine immobilization is in place, if indicated.
6. Preoxygenate and ventilate with 100% O2 using bag-valve mask.
7. Second EMT applies cricoid pressure.
8. Airway is visualized directly using laryngoscope, following accepted procedure.
• do not rock or lever the laryngoscope on the patient’s teeth
9. When vocal cords have been visualized, pass tracheal tube through the cords.
10. Inflate tracheal tube cuff if using a cuffed tube.
11. Begin ventilation and confirm tube placement following accepted procedure.
• confirmation of tube placement must include end-tidal CO2 detection
• ensure the end-tidal CO2 detection device used is age- or weight-appropriate
12. Release cricoid pressure.
13. Secure tracheal tube. Do not cut tracheal tube.
14. Insert an oral airway or suitable alternative.
15. Initiate transport, unless other emergency condition requires immediate treatment.
Notes:
- Each attempt at intubation should be limited to thirty (30) seconds, with adequate oxygenation and ventilation between attempts.
- A maximum of two (2) attempts at tracheal intubation is permitted.
- Tracheal tube position must be checked frequently, and after any transfer or movement of the patient, because tube displacement occurs easily in pediatric patients.
Indications
1. Unconscious patient with no gag reflex requiring airway protection.
Suggested Tracheal Tube Sizes and Depth
Procedure1. Perform patient assessment and record vital signs, level of consciousness, and
oxygen saturation.
2. Assess that patient meets criteria for this protocol.
3. Ensure there are no contraindications to use of this protocol.
4. Initiate basic life support treatment measures, including supplemental oxygen.
- these take precedence over management using this protocol
5. Ensure cervical spine immobilization is in place, if indicated.
6. Preoxygenate and ventilate with 100% O2 using bag-valve mask.
7. Second EMT applies cricoid pressure.
8. Airway is visualized directly using laryngoscope, following accepted procedure.
• do not rock or lever the laryngoscope on the patient’s teeth
9. When vocal cords have been visualized, pass tracheal tube through the cords.
10. Inflate tracheal tube cuff if using a cuffed tube.
11. Begin ventilation and confirm tube placement following accepted procedure.
• confirmation of tube placement must include end-tidal CO2 detection
• ensure the end-tidal CO2 detection device used is age- or weight-appropriate
12. Release cricoid pressure.
13. Secure tracheal tube. Do not cut tracheal tube.
14. Insert an oral airway or suitable alternative.
15. Initiate transport, unless other emergency condition requires immediate treatment.
Notes:
- Each attempt at intubation should be limited to thirty (30) seconds, with adequate oxygenation and ventilation between attempts.
- A maximum of two (2) attempts at tracheal intubation is permitted.
- Tracheal tube position must be checked frequently, and after any transfer or movement of the patient, because tube displacement occurs easily in pediatric patients.
Thursday, May 1, 2008
case 0001
Name: H. S. Tawfeek 28y
CESAREAN SECTION
EMERGENCY - FETAL DISTRESS
GENERAL ANESTHESIA - IRRITABLE PATIENT
N.B. extravasation of 400mg Thiopental and 80mg succinylcholine
delayed action and relaxation started 10 minutes later then 100mg ketamine is administered
intubation done and anesthesia maintained with 1% halothane and no further muscle relaxant
recovery normal
GENERAL ANESTHESIA - IRRITABLE PATIENT
N.B. extravasation of 400mg Thiopental and 80mg succinylcholine
delayed action and relaxation started 10 minutes later then 100mg ketamine is administered
intubation done and anesthesia maintained with 1% halothane and no further muscle relaxant
recovery normal
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