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Julian Dodd
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Theoretical background to tracheobronchial suction
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INTRODUCTION Intubation is required when a patient has difficulty breathing and needs ventilatory assistance. A hollow tube is inserted into the trachea and held in place by a small inflated balloon. INDICATION OF ENDOTRACHEAL TUBE INSERTION ACUTE RESPIRATORY FAILURE CENTRAL NERVOUS SYSTEM DEPRESSION NEUROMUSCULAR DISEASE PULMONARY DISEASE CHEST WALL INJURY UPPER AIRWAY OBSTRUCTION ASPIRATION PROPHYLAXIS FRACTURE OF CERVICAL VERTEBRAE WITH SPINAL CORD INJURY. Equipment required Suction catheter Oxyen, Bag valve mask(Ambu bag) Laryngoscope (two curved blades and straight blade) Stylet /bougie Endotracheal tubes (preferred size and smaller) Magills forceps Drugs (muscle relaxant, sedative) Xylocaine jelly Syringe for cuff inflation Tape to secure tube PROCEDURE Assess the patient’s heart rate, LOC and respiratory status Remove the patient dental bridgework and plates Prepare equipments Complications of intubation Early complications Trauma, e.g. haemorrhage, mediastinal perforation Haemodynamic collapse, e.g. positive pressure ventilation, vasodilation, arrhythmias or rapid correction of hypercapnia. Tube malposition, e.g. failed or endobronchial intubation. Later complications Infection including maxillary sinusitis if nasally intubated Cuff pressure trauma (maintain cuff pressure <25cmH2O) Mouth /Lip trauma
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