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Questions and Answers
What is a potential complication that can arise during orotracheal intubation?
Which of the following is an advantage of endotracheal intubation?
What is a disadvantage of endotracheal intubation?
How is a curved blade (Mac) used during intubation?
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What is the function of the stylet in endotracheal intubation?
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Which step is crucial before securing the endotracheal tube?
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What might be a consequence of trauma during endotracheal intubation?
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What is the correct technique for inserting the blade during intubation?
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What is the maximum duration for tracheobronchial suctioning?
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Which condition makes a patient a contraindication for the use of supraglottic airways?
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What type of medication does ketamine represent?
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What is the onset time for succinylcholine, a depolarizing neuromuscular blocker?
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What is a potential complication associated with the use of supraglottic airways?
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What is the recommended preoxygenation duration before intubation?
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What is the maximum dose of Fentanyl recommended for pain management?
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Which sedative has a slower onset time compared to the others listed?
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Study Notes
Complications of Orotracheal Intubation
- Intact gag reflex can hinder intubation success.
- Inability to open the mouth may result from trauma, dislocation, or pathological conditions.
- Difficulty visualizing the glottic opening poses significant challenges.
- Presence of copious secretions, vomitus, or blood in the airway complicates the process.
Advantages of ET Intubation
- Provides a secure airway and protects against aspiration.
- Facilitates direct access to the trachea for ventilation.
Disadvantages of ET Intubation
- Requires special equipment and expertise.
- Does not offer filtration, warming, or humidification of air.
Curved vs. Straight Blade Usage
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Curved Blade (Macintosh):
- Positioned in the vallecula to lift the epiglottis indirectly, exposing the vocal cords.
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Straight Blade (Miller):
- Designed to lift the epiglottis directly, often preferred for infants and children.
Stylet Purpose and Usage
- Inserted into the ET tube to shape and maintain its form.
- Guides the tip of the tube over arytenoid cartilage into the vocal cords, placed ½ inch before the eye of Murphy.
- End bent to resemble a hockey stick, aiding insertion.
Trauma from ET Intubation
- Potential injuries include bleeding, hypoxia, laryngeal swelling, laryngeal spasm, vocal cord damage, mucosal necrosis, and barotrauma.
Blade Insertion Techniques
- Enter the right side of the mouth and sweep the tongue leftward using the blade flange.
- Position blade in the midline to facilitate intubation.
Steps for ET Intubation Insertion
- Inspect for proper tube placement.
- Verify chest rise/fall and auscultate lungs/epigastrium.
- Check End-Tidal CO2 (ETCO2) levels before securing the tube.
Waveform Points in ETCO2 Monitoring
- ^ indicates exhalation, v indicates inhalation.
- D denotes maximum ETCO2 level (ET#).
Tracheobronchial Suctioning
- Duration should not exceed 10 seconds to minimize complications.
Upper Airway Burns
- Monitor for potential airway complications following burns.
Indications and Contraindications of Supraglottic Airways
- Indication: Inability to undergo ET intubation.
- Contraindications: High airway pressures, gag reflex, esophageal disease, ingestion of caustic substances, and obesity can increase risks.
- Laryngeal Mask Airway (LMA) Complications: Risk of aspiration, less effective in obese patients, and contraindicated in those with morbid obesity, pregnancy, high hiatal hernia, or increased regurgitation risk.
Effects of Sedatives, Opioids, and Dissociative Anesthetics
- Sedatives: Reduce anxiety, induce amnesia, and decrease the gag reflex.
- Dissociative Anesthetics: Create a sense of detachment and distort perception of sights and sounds.
- Opioids: CNS depressants that induce insensibility or stupor.
Sedative Dosages
- Etomidate: 0.2 - 0.6 mg/kg, Ketamine: 1-2 mg/kg, Midazolam: 0.2 - 0.6 mg/kg IV over 30-60 seconds, Lorazepam: 0.1 mg/kg with saline over 2 minutes, Diazepam: 5 mg IV or 10 mg IM.
Opioid Dosages
- Fentanyl: 1 mcg/kg for pain relief, with a maximum of 100 mcg.
Neuromuscular Blocking Agents
- Succinylcholine: Onset in 60 seconds, duration 4-6 minutes (depolarizing).
- Vecuronium Bromide: Onset in 2 minutes, duration 45 minutes (non-depolarizing).
- Rocuronium: Onset in 2 minutes, duration 30-60 minutes (non-depolarizing).
- Pancuronium: Onset in 3-5 minutes, duration 60 minutes (non-depolarizing).
- These agents affect all skeletal muscles, including the diaphragm and intercostals.
Preoxygenation Protocol
- Administer oxygen for 2-3 minutes prior to intubation to optimize oxygen saturation.
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Description
Test your knowledge on the complications associated with orotracheal intubation, including factors like intact gag reflex and visibility of the glottic opening. Learn about the advantages and disadvantages of endotracheal intubation and the differences between curved and straight blades.
