Airway Assesment Of The Difficult Airway Before Manipulation

Airway management is a vital part of the job of an Emergency Medical Technician (EMT). The airway is the first thing an EMT must assess in all patients, with the exception of arterial bleeding. Improper, or lack thereof, management of the airway will kill a patient; therefore EMTs must master management of the airway, for fear of dire consequences if done incorrectly. The purpose of the airway is to remove carbon dioxide and transport oxygen to the blood.

BACKGROUND: Tracheal intubation may induce; hypertension, tachycardia, and/or arrhythmia. Fentanyl is a frequently used opioid that joins with hypnotic agents to diminish hemodynamic responses to tracheal intubation. Furthermore, lidocaine has a suppressive effect on the circulatory responses in patients undergoing laryngoscopy and tracheal intubation. However, intravenous lignocaine has shown variable results and large doses of fentanyl causes hypotension and cough. We compared the effectiveness of intravenous lignocaine 1.5mg/Kg bolus and intravenous fentanyl 2mcg/Kg bolus in attenuating the sympathetic response to laryngoscopy and tracheal intubation.

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

This study focuses on methods to confirm proper tube placement. Through a cross sectional study, the research concluded that over seventy eight percent of critical care health workers use multiple methods to confirm tube placement. Some of the more common methods include looking at the gastric aspirate’s pH, observing the patient for signs or respiratory distress, and capnography. Auscultation of the air bolus was not included in the study because it was deemed “unreliable”. However, a small separate study was done and about eighty eight percent of critical care health workers claimed they also used an air bolus auscultation as a method of confirming placement. So, what is the reasoning for health care workers to continue doing this if it is unreliable? It has been hypothesized that this method requires the least amount of supplies and the nurses can do it quickly and easily. This research study along with many others concludes that air bolus auscultation is not an accurate method because the sounds nurses are used to hearing that “confirm” proper tube placement in the gastrointestinal tract are the same as sounds heard in the lungs and other areas of the

The key concept underpinning the role of the anaesthetic nurse in an unanticipated difficult intubation as part of the multidisciplinary theatre team is essential; as a lead provider of compassionate anaesthetic care (Fynes et al, 2014), as a communicator, have the courage to advocate, be competent and committed (DOH, 2012). These are very important for enhancing patient anaesthetic care and improving patient safety (NPSA, 2010). And above, to improve the knowledge and skills by continuous training is vital in the event of a difficult intubation in adults, pregnant women and children (Brien and Conlon, 2013; Clark and Nolan, 2010). The incident confirms that to improve airway management, especially in the event of a difficult intubation planning, training and practising (such as in simulation centres) for the unanticipated difficult airway for the anaesthetist, anaesthetic nurse and theatre staff as a whole, is vital and it highlighted that our practice around managing the airway needs to be improved and constantly updated (Mellanby, Podmore and McNarry, 2014), and that is why I have applied to take part in the new airway simulation training

One of the most important things to maintain a trauma patients airway is ensuring that you have adequate help around (Stephens, 2011). This is important because there are many different tasks that must be delegated in maintaining this persons airway. Some of these processes include opening the airway, suctioning the airway, inserting the proper adjunct, and maintaining

The major variables were labeled in association with the endoscopic photographs from the computer-assisted measurement (CAM) airway analysis at the retropalatal level with calibrator in regards to showing airway dimensions in both pre and postoperative images (Hsu et al., 2007). There was no sign of manipulation of these variables other than from the postoperative images. The research team compiled the data to show the regression data of UPPP surgery were considerably correlated with postoperative improvement. This method of data collection was used to analyze the correlation between modifications in surgical parameters and the postoperative status of OSA patients.

Shallow breathing and pain altered this patient’s comfort. Therefore, one of the nursing diagnoses can be stated as “Breathing Pattern, Ineffective r/t pain and anxiety, as evidenced by respiratory depth changes" (Ackley & Ladwig p. 175). We briefly discussed the specifics of incentive spirometry use before initiating the intervention. After return demonstration, the patient was ready to use his incentive spirometer.

The main priority for all the pediatric patient was to make sure they are getting enough air. They needed an open airway. Without an open airway nothing else matters. To help with the patients airways we monitored their O2 sats and if they were low we made sure to apply oxygen, and continue to monitor their sats. Once oxygen was applied we worked on

In the field of emergency medicine there are few things that are valued as much as a patent airway. From the very beginning stages of training in emergency care we are taught to monitor for airway, breathing and circulation .A patent airway is a very important part of the ABCs triangle necessary to support life. There are many causes of airway compromise, however we will look at basic foreign body airway obstructions and what we can do to fix them.

Managing complex ventilator patients require critical thinking to solve problems pertaining to ventilator issues. Even though I am a certified ventilator paramedic, ventilator management is managed an respiratory therapist. Having the ventilator certification was useful in which I was able to apply my knowledge to

A tracheostomy, or trach, is a surgically created opening in the trachea. A tracheostomy tube, or trach tube, is a tube that is placed in this opening to help with breathing. It is important to take good care of your trach and trach tube. This will help you stay safe and free from infection.

Overall, the knowledge and expertise an anesthesiologist acquired allows them conduct preoperative procedures and evaluations of patients before undergoing an operation to ensure the best possible operational safety for the patient. The evaluation of patients is important because of numerous factors that can could possibly lower the effectiveness of the anesthetics being used or severely endanger a patient. Before an operation an anesthesiologist must evaluate a healthy patient with a systems approach. This procedure usually evaluates the airway, pulmonary system, neurologic system, cardiovascular system, and endocrine system(Hata p.585-588). Each of the systems that need to be evaluated have different methods or procedures to ensure the best

The patient was a five year old male, fit and well in himself, with no allergies other than a mild Asthma. This would classify the patient ASA 2 according to the American Society of Anaesthesiologists (ASA).This means that the patient has a mild systemic disease that does not limit activity and is well controlled with the use of inhalers, (Simpson PJ and Popat M 2002). He was listed for an Adenotonsillectomy under general anaesthesia and was brought to the anaesthetic room with his mother accompanied by a member of the Ward Staff. The Operating Department Practitioner (ODP) and I introduced ourselves and I explained that I was a Student ODP and if there were no objections, that I would be assisting with the care and preparation of the patient for theatre. This is in keeping with HCPC 2012 (pg 9-10).

If difficulty was predicted early, then more senior help with advanced airway management could be sought.