Sellick: The Use Of Cricoid Pressure

All patients are at risk of pressure injuries. This risk is exacerbated when immobility and limited access to the surgically draped patient are a part of

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

On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used

Patients who have suffered a traumatic injury may have a variety of different fluids and objects in their throat that could be obstructing it (Stephens, 2011). For example there could be blood, bodily fluids, and even teeth is the patient broke any teeth (Stephens, 2011). In order to clear this persons airway first the paramedic should observe for any large foreign bodies obstructing the airway, and if they can try to finger sweep it out (Stephens, 2011). If there are any fluids obstructing the patients airway the paramedic will suction the patients airway. The proper way to suction is to not go past the base of the patients tongue, and to suction as you are pulling the device out (Stephens, 2011). The maximum amount of time to suction an adults airway is fifteen seconds, and the maximum amount of time you can suction a child's airway is ten seconds (Stephens, 2011). The medic should always keep the suction on hand even after an airway has been inserted in case the patients airway needs to be suctioned

Instilling normal saline solution before endotracheal suctioning improves oxygenation, facilitates removal of secretions, and stimulates coughing to mobilize secretions. Is this to be considered evidence practice? Suctioning is one of the main procedures used by respiratory therapist and nurses in the acute care and home health to help patients who require the use of a ventilator. According to the literature there is little research supporting the practice of instilling normal saline prior to suctioning. In contrast, studies have revealed this practice is more dangerous because it increases the risk of ventilator associated pneumonia. (Miller, Drummond, & Carey, 2015). This type of pneumonia occurs when bacteria is present in the saline vials. The evidence based practice of sacred cow proposes this practice of saline instillation prior to suctioning a patient prior to intubation should not be done.

Endotracheal tubes containing a tapered cuff have recently been approved by the United States Food and Drug Administration and, based on the findings from in vitro and in vivo studies, are believed to achieve a better tracheal seal (Bowton et al., 2013). This enhanced fit is suggested to reduce the passage of potentially contaminated secretions around the cuff and into the distal airway of mechanically ventilated patients, thereby decreasing the development of VAP. In a study executed by Bowton et al. (2013), researchers examined whether these tapered endotracheal tubes would be more effective in reducing actual rates of VAP. Their study utilized a two-period observational approach in which each study period took place over six of the same calendar months so as to eliminate potential variations in season related to VAP. All adults over the age of 18 who were admitted into a variety of specialized ICUs, whose VAP rates closely resembled the average of all ICUs in the United States, were included in the study. During the first six month period, all endotracheal tubes utilized by the facility contained the standard, barrel-shaped cuff. Following this period, an audit was performed to ensure that all of these tubes were removed and, subsequently, they were replaced with tapered-cuff endotracheal tubes. Additionally, all emergency medical

Upon arriving at the scene, the advanced care paramedic would begin the primary survey. All dangers would be assessed, including environmental dangers, animals, agitated bystanders and any other alarming cues. Once all dangers have been assessed the ACPs begin investigating the patient’s responsiveness using the acronym AVPU (QLD.gov.au, 2016). An assessment of their alertness, verbal response, response to painful stimuli or unconsciousness is completed. Once assessed, the patient’s airway is then checked to be clear of any obstructions to ensure proper respiration can occur, at this point, the triple airway manoeuvre would be adjusted to only the opening of the mouth and the jaw thrust (QLD.gov.au, 2015). If the patient complains of neck and back tenderness, neurological deficit, evidence of intoxication or a distracting injury (QLD.gov.au, 2016. 2) spinal immobilisation is required to ensure no further damage to the spinal cord occurs or an aid to keep the patient as calm as possible if a distracting injury (Hodegetts et al., 2011). The patient's breathing should then be assessed now that the spine in immobilised to ensure the depth, rate and rhythm of the breaths are adequate. If needed an oropharyngeal airway may need to be inserted into the mouth to keep the tongue from blocking the airway if it is tolerated (Higginson et al,. 2013). Lastly, in the primary survey, the

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.

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

Respiratory emergencies can be caused by obstructions, inflammations, trauma, and several different disease processes. The most common obstruction of the airway is the tongue. This usually occurs when the patient has become unconscious secondary to another cause such as intoxication, low blood sugar, or trauma. While tongue obstruction of the airway can have deadly results, it can be easily solved by re-positioning the airway using the either the jaw thrust maneuver if trauma is suspected, or the head-tilt chin-lift if no trauma is suspected. Also if the patient is unconscious and has no gag reflex you can use an oropharyngeal airway to hold the tongue up and out of the airway. However, using an oropharyngeal airway does not mean that you can

The medical field is very fast-paced and new technological discoveries are constantly being made. When one thinks of new medical findings, cancer cures and surgery are common thoughts. However, a very interesting and slightly controversial discovery has been made in the neonatal world. The Neurally Adjusted Ventilatory Assist (NAVA) is “a form of partial ventilator assistance in which the machine delivers assistance in proportion to the electrical activity of the diaphragm (EAdi), as assessed by means of transesophageal electromyography” (Gianmaria Cammarota et al., 2011). It is meant to lower inspiratory pressure and respiratory muscle load in preterm infants (Gianmaria Cammarota et al., 2011). In other words, it helps the patient- whether they be an infant or an adult- breathe when their lungs aren’t able to aid in that process. M. Ferrer and P. Pelosi, authors of “European Respiratory Monograph 55: New Developments in Mechanical Ventilation” say that the signal from the EAdi is used to regulate NAVA, which then causes the airways to receive pressure. “With NAVA, both timing and the magnitude ventilator delivered assistance are controlled by the EAdi” (M. Ferrer & P. Pelosi., 2012, p 116). My research proves that NAVA can work better than pressure support ventilation (PSV) and can be used not only for neonates, but patients in the ICU that are affected by lung-related injury or illness that causes them to have difficulty breathing on their own; though there are

This crus arises from the anterior longitudinal ligament overlying the lumbar vertebrae and encircles the distal esophagus in a scissorlike fashion to form a 2-cm long hiatal canal. The proximal one-third of the LES is located proximal to the diaphragm and the distal two-thirds of the sphincter is below the diaphragm and intra-abdominal. The extrinsic sphincter component of measured LES pressure is formed by the striated muscular fibers of the diaphragm. The basal tonic pressure of the LES is mainly from the esophageal components of the sphincter, and the superimposed increments in pressure during inspiration are caused by contractions of the crural diaphragm. The magnitude of the increase in pressure during inspiration is directly proportional to the force of contraction of the crural diaphragm. During tidal inspiration, the increase in GEJ pressure is much smaller than during deep inspiration. The crural diaphragm also rapidly contracts during events that increase intra-abdominal pressures (coughing, abdominal compression, and straight leg raising), thereby protecting against reflux that might occur with these increases in gastric pressure. Both the LES and crural diaphragm relax with the initiation of swallowing and the distal esophagus and LES are pulled 1 cm-2 cm upward by the contractions of the longitudinal muscles. The peristaltic wave pushes the bolus in a distal direction

When performing CPR on a patient using a CPR mask is one of the most important pieces of equipment needed. When performing CPR many people fail to get the correct seal from mask to the patient’s face, if the mask does not have the correct seal the oxygen will leak from many areas of the mask but most common area for oxygen to leak is from the cheeks of the patient. When the correct seal is applied and the size of the mask fits the patients face correctly the CPR procedure can be carried out correctly. The whole purpose of a CPR mask with an airtight seal is so that oxygen can be delivered to the patient lungs resulting in expanding the chest of the patient, the correct size of a mask should cover the spaces between the bridge

In order to make sure that the victims airway is open,place your hand on the victims forehead and two fingers on their chin and tilt the head back slightly to open the airway.Look, listen, and feel for breathing. Get close enough to the victims face to listen if victim can breath by putting you ear close to the victims mouth. At the same time ,look if victims chest is rising up.Do that for ten seconds.If you do not feel the victims breath, or cannot see the chest rising after ten seconds, continue to the next step.

Tracheostomys may be required for long term control of excessive bronchial secretions, particularly in those with reduced consciousness or to maintain an