ICU Medical Disposable Supplies Instruments Book PDF

‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجود...

‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ ICU Medical Disposable Supplies Instruments Book ICU Medical Equipment 1 ICU Beds 2 Defibrillators 3 Patient Monitors 4 Mechanical Ventilators 5 Blood Gas Analyzers 6 Hemodialysis Machines 7 Oxygen cylinders 8 Fiberoptic (Bronchoscopes) Laryngoscopes 9 Video Laryngoscope 10 Jet Ventilation Equipment 11 ECG Machines 12 Portable x Ray Machine 13 Infusion (Syringe) Pumps ICU Medical Disposable Instruments 14 Stethoscope 15 Manual BP Apparatus 16 Reducing valves 17 Oxygen flowmeters 18 Disinfectant Dispenser 19 Laryngoscopes 20 Supraglottic Airway Devices 21 Endotracheal Tubes 22 Bougies 23 Stylets 24 Magill Forceps 25 Guedel airways 26 Nasopharyngeal Airways 27 Oxygen Face Masks 28 Nasal Cannula 29 Bag-Valve Masks (BVM)  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 30 Ambu Bags 31 Air Mattress 32 Capnography Devices 33 Suction Machine 34 Pulse Oximeters 36 Lubricating Gel 37 Gowns 38 Medical Masks 39 Gloves 40 Chest Tubes 41 Urinary Catheters 42 Urine Bags 43 Syringes 44 Dressings Gauze 45 Bandages 46 IV Cannulas 47 IV Tubing Set 48 IV Connectors 49 Central Venous Line (Catheter) kit 50 Arterial line (Catheter) Kit 51 Cricothyrotomy Kits 52 Breathing Circuits 53 Blood Set 54 Pacemakers 55 Suction Catheters 56 Yankauer Suction Tips  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ ICU Medical Equipment Comprehensive list of the medical supplies, equipment, and medications that should be available in a trolley for cases of difficult ventilation and difficult endotracheal intubation 1 ICU Beds Intensive care unit (ICU) patient beds come in various types and configurations, each designed to meet the specific needs of critically ill patients. Here are some common types and medical specifications of ICU patient beds: 1) Standard ICU Bed: Specifications: Typically equipped with adjustable height, backrest, and leg elevation, allowing for optimal patient positioning. Features: Side rails for patient safety, built-in weighing scale, Trendelenburg and reverse Trendelenburg positioning options. Advantages: Versatile and adaptable to different patient needs, facilitates nursing care and patient comfort. 2) ICU Bed with Advanced Monitoring: Specifications: Includes integrated monitoring systems for vital signs such as heart rate, blood pressure, and oxygen saturation. Features: Bedside touch-screen interface for real-time display of patient parameters, alarms for abnormal readings. Advantages: Allows for continuous monitoring of patient status without additional equipment, facilitates early detection of changes in condition. 3) Critical Care Bed with Specialized Surfaces: Specifications: Features pressure-relieving surfaces such as air mattresses or alternating pressure overlays. Features: Dynamic pressure redistribution to prevent pressure ulcers and promote skin integrity, adjustable firmness and support levels. Advantages: Reduces the risk of pressure injuries, provides comfort for patients with limited mobility or prolonged bed rest. 4) Bariatric ICU Bed: Specifications: Extra-wide and reinforced frame to accommodate larger patients and higher weight capacities. Features: Wide range of adjustable positions, heavy-duty side rails for patient safety, integrated scale for accurate weight monitoring. Advantages: Supports the care of obese or morbidly obese patients, enhances patient comfort and safety during critical illness. 5) ICU Bed with Mechanical Ventilation Integration: Specifications: Designed to accommodate patients requiring mechanical ventilation, with integrated ventilator mounts and tubing management systems. Features: Bedside controls for ventilator settings and alarms, built-in oxygen and air supply ports. Advantages: Streamlines the management of ventilated patients, facilitates close monitoring and adjustment of ventilation parameters.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 6) ICU Bed with X-ray Transparency: Specifications: Features radiolucent sections in the bed frame or mattress platform to allow for X-ray imaging without patient repositioning. Features: Adjustable head and foot sections for optimal patient positioning during imaging procedures. Advantages: Facilitates bedside diagnostic imaging studies, reduces the need for patient transfers and potential complications. Summary: ICU patient beds are designed with various features and specifications to meet the complex needs of critically ill patients. The choice of bed depends on factors such as patient condition, medical requirements, and facility resources, with the goal of providing safe and effective care while optimizing patient comfort and outcomes.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 2 Defibrillators Defibrillators are medical devices used to deliver an electrical shock to the heart to restore normal heart rhythm in cases of cardiac arrhythmias, particularly ventricular fibrillation or pulseless ventricular tachycardia. There are different types of defibrillators, each with its own functions, indications, contraindications, advantages, and disadvantages: Types: 1. Automated External Defibrillators (AEDs) 2. Manual External Defibrillators 3. Implantable Cardioverter-Defibrillators (ICDs) 4. Wearable Cardioverter-Defibrillators (WCDs): 1. Automated External Defibrillators (AEDs): Functions: Designed for use by non-medical personnel, they analyze the heart rhythm and deliver a shock automatically if indicated. Indications: Used in cases of sudden cardiac arrest in public places, homes, or workplaces. Contraindications: Not indicated for patients with a pulse or in situations where a manual defibrillator is available. Advantages: Easy to use with minimal training, can be used by laypersons in emergency situations. Disadvantages: Limited functionality for advanced cardiac monitoring or pacing, may not be suitable for certain patient populations. 2. Manual External Defibrillators: Functions: Require trained healthcare providers to analyze the heart rhythm and manually deliver a shock using paddles or pads. Indications: Used in hospitals, clinics, or pre-hospital settings by trained medical personnel for cardiac arrest or unstable arrhythmias. Contraindications: Not indicated for patients with a pulse or in situations where immediate advanced cardiac care is available.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Advantages: Provides more control and flexibility in energy delivery and cardiac monitoring, suitable for advanced cardiac life support (ACLS) protocols. Disadvantages: Requires specialized training for proper use, may not be readily available in all settings. 3. Implantable Cardioverter-Defibrillators (ICDs): Functions: Surgically implanted devices that continuously monitor the heart rhythm and deliver shocks as needed to terminate life-threatening arrhythmias. Indications: Used in patients with a history of ventricular arrhythmias, sudden cardiac arrest survivors, or those at high risk of sudden cardiac death. Contraindications: Generally contraindicated in patients with reversible causes of sudden cardiac arrest or those with limited life expectancy. Advantages: Provides continuous monitoring and immediate therapy for arrhythmias, reduces the risk of sudden cardiac death. Disadvantages: Invasive procedure for implantation, risk of complications such as infection or device malfunction. 4. Wearable Cardioverter-Defibrillators (WCDs): Functions: External defibrillator worn by patients at risk of sudden cardiac arrest, continuously monitors heart rhythm and delivers shocks if needed. Indications: Used in patients awaiting further evaluation or decision regarding ICD implantation, or those with temporary risk factors for sudden cardiac arrest. Contraindications: Not indicated for patients with certain arrhythmias or those unable to tolerate wearing the device. Advantages: Provides temporary protection against sudden cardiac death, can be worn outside the hospital setting. Disadvantages: Limited patient acceptance due to device size and appearance, may have false alarms or inappropriate shocks. Summary: Each type of defibrillator has specific functions, indications, contraindications, advantages, and disadvantages. The choice of defibrillator depends on the patient's clinical condition, the setting in which it will be used, and the expertise of the healthcare providers. Rapid recognition of cardiac arrest and prompt initiation of appropriate defibrillation is crucial for improving survival outcomes in patients with life-threatening arrhythmias.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 3 Patient Monitors Patient monitoring devices come in various types, each with its own functions, advantages, and disadvantages. Here are some common types: 1. Vital Signs Monitors: Functions: Monitor basic vital signs such as heart rate, blood pressure, temperature, and oxygen saturation (SpO2). Advantages: Provide real-time data, non-invasive, easy to use. Disadvantages: Limited scope of monitoring, may not detect subtle changes, may require calibration. 2. Electrocardiogram (ECG) Monitors: Functions: Monitor electrical activity of the heart, detecting abnormalities in heart rhythm.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Advantages: Essential for diagnosing cardiac arrhythmias, provides detailed cardiac data. Disadvantages: Requires specialized training to interpret, may have false alarms. 3. Pulse Oximeters: Functions: Measure oxygen saturation (SpO2) in the blood non-invasively. Advantages: Quick and easy to use, provides continuous monitoring of oxygen levels. Disadvantages: Accuracy can be affected by motion or poor perfusion. 4. Capnography Monitors: Functions: Measure the concentration of carbon dioxide (CO2) in exhaled breath. Advantages: Provides information about ventilation and perfusion, early detection of airway obstruction or respiratory depression. Disadvantages: Requires proper placement of sensors, may not be suitable for all patients. 5. Blood Pressure Monitors: Functions: Measure arterial blood pressure, including systolic and diastolic pressures. Advantages: Important for assessing cardiovascular function, available in various types (e.g., manual, automated). Disadvantages: May be uncomfortable for patients, accuracy can be affected by movement or improper cuff size. 6. Respiratory Rate Monitors: Functions: Monitor the rate of breathing, usually measured in breaths per minute. Advantages: Important indicator of respiratory status, can detect changes in breathing patterns. Disadvantages: Accuracy may be affected by patient movement or shallow breathing. 7. Intracranial Pressure (ICP) Monitors: Functions: Measure pressure inside the skull to assess brain function and detect intracranial hypertension. Advantages: Essential for managing patients with head injuries or neurological conditions. Disadvantages: Invasive procedure, risk of infection or bleeding, requires specialized placement and monitoring. 8. Cardiac Output Monitors: Functions: Measure cardiac output, stroke volume, and other hemodynamic parameters. Advantages: Provides valuable information about cardiac function and fluid status. Disadvantages: Invasive methods require catheterization; non-invasive methods may have limitations in accuracy. Summary:  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Each type of patient monitoring device has its own specific functions, advantages, and disadvantages. The choice of device depends on the patient's condition, monitoring needs, and clinical setting. It's important for healthcare providers to understand the capabilities and limitations of each device to ensure accurate and effective patient monitoring. 4 Mechanical Ventilators Ventilators are crucial devices in critical care, used to support or replace the respiratory function in patients who are unable to breathe adequately on their own. Here’s an overview of the uses of ventilators, their indications for use, and contraindications: Uses of Ventilators: 1. Support for acute and chronic respiratory failure. 2. Assistance during surgery. 3. Management of severe infections, trauma, and neuromuscular disorders. 4. Acute Respiratory Failure: To provide respiratory support when the lungs cannot adequately oxygenate the blood or remove carbon dioxide. 5. Surgery: To ensure adequate ventilation and oxygenation during general anesthesia. 6. Neuromuscular Disorders: For patients with conditions that impair the muscles needed for breathing (e.g., ALS, myasthenia gravis). 7. Severe Infections: Such as pneumonia or sepsis, which can compromise respiratory function. 8. Chronic Respiratory Conditions: Such as chronic obstructive pulmonary disease (COPD) exacerbations, where the patient experiences acute worsening of respiratory function. 9. Trauma: To manage patients with severe injuries affecting breathing, such as chest trauma or head injuries. 10.Cardiac Conditions: In cases of heart failure or cardiac arrest, where respiratory support is needed to stabilize the patient.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Indications for Use 11.Hypoxemic Respiratory Failure: Inadequate oxygenation (PaO2 < 60 mmHg) despite supplemental oxygen. 12.Hypercapnic Respiratory Failure: Elevated carbon dioxide levels (PaCO2 > 50 mmHg) with acidosis (pH < 7.35). 13.Airway Protection: In patients who are at risk of airway obstruction or aspiration. 14.Apnea: Absence of breathing due to neurological or muscular conditions. 15.Severe Respiratory Distress: Such as in acute respiratory distress syndrome (ARDS), characterized by severe shortness of breath and hypoxemia. 16.Postoperative Support: Following major surgeries, especially thoracic or abdominal surgeries, where respiratory function may be compromised. 17.Cardiopulmonary Arrest: During resuscitation efforts and post-resuscitation care to ensure adequate ventilation and oxygenation. Contraindications for Use 18.Do Not Resuscitate (DNR) Orders: Patients with a DNR order or other advanced directives indicating they do not want mechanical ventilation. 19.Terminal Illnesses:** Where ventilation would not improve the quality of life or alter the course of the disease, and palliative care is preferred. 20.Irreversible Neurological Damage: In cases where brain death has been established. 21.Severe Cardiopulmonary Instability: Where ventilation may exacerbate the condition rather than improve it. 22.Refusal by Patient or Family: If the patient or their healthcare proxy refuses mechanical ventilation based on informed decision-making. 23.Severe Airway Obstruction: Where intubation is not possible, and alternative methods of airway management are not viable. 24.Inadequate Resources: Situations where the necessary infrastructure, such as monitoring and skilled personnel, is not available to safely manage a ventilated patient. Understanding these aspects helps healthcare providers make informed decisions about the use of ventilators, ensuring appropriate and ethical patient care.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 5 Blood Gas Analyzers The ABG (Arterial Blood Gas) device is a medical tool used to measure the levels of oxygen (O2), carbon dioxide (CO2), and pH in arterial blood. Here's a brief overview of how it works, its function and uses, as well as its advantages and disadvantages: ABG device work:- - The ABG device collects a small sample of arterial blood, typically from an artery in the wrist or groin, using a syringe or specialized arterial blood gas sampler. - The blood sample is then analyzed for levels of oxygen, carbon dioxide, pH, bicarbonate (HCO3-), and other parameters using a blood gas analyzer. - The results are displayed as numerical values representing the concentrations of each gas and pH level in the arterial blood. Uses of ABG device: - **Assessment of Respiratory and Metabolic Function: ** The primary function of the ABG device is to assess the adequacy of respiratory and metabolic function by measuring levels of oxygen and carbon dioxide, as well as pH and bicarbonate.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ - **Diagnosis and Management of Acid-Base Disorders: ** It is used to diagnose and manage acid-base disorders such as respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. - **Monitoring Critically Ill Patients: ** ABG analysis is commonly performed in critically ill patients, including those with respiratory failure, shock, sepsis, and trauma, to guide treatment and monitor response to therapy. Advantages of ABG device: 1. **Comprehensive Assessment: ** Provides a comprehensive assessment of respiratory and metabolic function, including oxygenation, ventilation, and acid-base balance. 2. **Real-time Results: ** Offers real-time results, allowing for immediate clinical decision-making and intervention. 3. **Direct Measurement: ** Provides a direct measurement of arterial blood gases, which is more accurate than indirect methods such as pulse oximetry or venous blood gas analysis. Disadvantages of ABG device: 1. **Invasive Procedure: ** Collecting arterial blood samples can be painful and carries a risk of complications such as bleeding, hematoma, and arterial thrombosis. 2. **Technical Skill Required: ** Performing ABG analysis requires technical skill and proficiency to ensure accurate sampling and interpretation of results. 3. **Time-consuming: ** The process of collecting and analyzing arterial blood samples can be time-consuming, especially in critically ill patients who require frequent monitoring. 4. **Cost: ** ABG analysis may be more costly compared to other diagnostic tests, especially in resource-limited settings. Summary: The ABG device is a valuable tool for assessing respiratory and metabolic function in critically ill patients. While it offers advantages such as comprehensive assessment and real-time results, it also has limitations such as invasiveness, technical skill requirements, and cost, which need to be considered when using it in clinical practice.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 6 Hemodialysis Machines The hemodialysis machine is a medical device used to perform hemodialysis, a treatment for patients with kidney failure. Here's a brief overview of how it works, its function and uses, as well as its advantages and disadvantages: Hemodialysis machine work: - - The hemodialysis machine works by pumping the patient's blood through a dialyzer, also known as an artificial kidney. - Inside the dialyzer, the blood flows through tiny tubes that are surrounded by a special dialysis fluid. - Waste products and excess fluids from the blood pass through the walls of the tubes and into the dialysis fluid, while essential substances remain in the blood. - The cleansed blood is then returned to the patient's body through a separate tube. Uses of the Hemodialysis machine: - **Treatment for Kidney Failure: ** The primary function of the hemodialysis machine is to remove waste products and excess fluids from the blood in patients with kidney failure, whose kidneys can no longer perform this function adequately. - **Regulation of Electrolytes: ** It helps regulate the levels of electrolytes such as sodium, potassium, and bicarbonate in the blood, which can become imbalanced in kidney failure.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ - **Management of Fluid Overload: ** Hemodialysis helps manage fluid overload by removing excess fluid from the body, which can lead to complications such as hypertension and edema in kidney failure patients. Advantages of the Hemodialysis machine: 1. **Effective Waste Removal: ** Hemodialysis effectively removes waste products and excess fluids from the blood, helping to maintain a balance of electrolytes and fluid levels in the body. 2. **Improves Symptoms: ** It helps alleviate symptoms associated with kidney failure, such as fatigue, nausea, and shortness of breath, improving the patient's quality of life. 3. **Long-term Treatment: ** Hemodialysis can be performed regularly on an outpatient basis, allowing patients with kidney failure to lead relatively normal lives and continue their treatment over the long term. Disadvantages of the Hemodialysis machine: 1. **Time-consuming: ** Hemodialysis sessions typically last for several hours and need to be performed multiple times per week, which can be time-consuming and disruptive to the patient's schedule. 2. **Vascular Access Complications: ** Patients undergoing hemodialysis require vascular access, such as an arteriovenous fistula or graft, which can be prone to complications such as infection, clotting, and stenosis. 3. **Risk of Hypotension: ** Hemodialysis can sometimes cause a drop in blood pressure (hypotension), leading to symptoms such as dizziness, nausea, and cramps during or after the procedure. Summary: The hemodialysis machine is a vital tool for the treatment of kidney failure by removing waste products and excess fluids from the blood. While it offers advantages such as effective waste removal and symptom improvement, it also has disadvantages such as time-consuming sessions, vascular access complications, and the risk of hypotension, which need to be considered in patient care.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 7 Oxygen Cylinders Fiberoptic (Bronchoscopes) 8 Laryngoscopes Fiberoptic bronchoscopes are medical devices used to visualize the inside of the airways, including the trachea and bronchi, for diagnostic and therapeutic purposes. They are typically classified based on their design, intended use, and the diameter of the insertion tube. Types of Fiberoptic (Bronchoscopes) Laryngoscopes: - 1. Flexible Fiberoptic Bronchoscope: This type of bronchoscope consists of a flexible insertion tube with a light source and a camera at the tip. It allows for visualization of the airways and can be maneuvered through the bronchial tree for diagnostic procedures such as biopsies, cytology, and foreign body removal. 2. Rigid Fiberoptic Bronchoscope: Rigid bronchoscopes have a straight, rigid insertion tube and are often used in surgical procedures such as bronchial dilation, stent placement, and laser therapy. Sizes of fiberoptic bronchoscopes  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Fiberoptic bronchoscopes are available in different sizes, typically measured in millimeters (mm) for the diameter of the insertion tube. Common sizes range from 2.8 mm to 6 mm for flexible bronchoscopes and up to 14 mm for rigid bronchoscopes. The use of oxygen during bronchoscopy depends on the patient's condition and the procedure being performed. Oxygen may be delivered through a nasal cannula or face mask at flow rates ranging from 2 to 6 liters per minute (L/min) for flexible bronchoscopy and up to 10 L/min for rigid bronchoscopy. The oxygen concentration delivered will depend on the flow rate and the type of oxygen delivery device used. Uses of fiberoptic bronchoscopes include diagnostic and therapeutic procedures such as bronchial biopsies, cytology sampling, foreign body removal, bronchial lavage, and bronchial stenting. Indications for fiberoptic bronchoscopy include evaluation of abnormal chest imaging findings (such as nodules or infiltrates), assessment of airway pathology (such as tumors or strictures), evaluation of hemoptysis, and assessment of suspected pulmonary infections. Contraindications to fiberoptic bronchoscopy may include patients with uncontrolled bleeding disorders, severe respiratory distress, or those at high risk of complications from sedation or anesthesia. Complications of fiberoptic bronchoscopy may include bleeding, pneumothorax, bronchospasm, infection, and adverse reactions to sedation or anesthesia. Proper patient preparation, monitoring, and post-procedure care are essential to minimize these risks. Fiberoptic bronchoscopy is a valuable tool in the diagnosis and management of various respiratory conditions, providing detailed visualization of the airways and enabling targeted interventions.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 9 Video Laryngoscope Video laryngoscopes are advanced airway management devices that incorporate a video camera and screen to provide a clear view of the patient's airway during intubation. They are typically classified based on their design, intended use, and method of insertion. Common types include: Types of Video laryngoscopes  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 1. Macintosh-style Video Laryngoscope: These laryngoscopes have a blade design similar to traditional Macintosh laryngoscopes but with a built-in video camera at the tip of the blade. They are often used for direct laryngoscopy and provide a view of the glottis on a screen. 2. Hyper-angulated Video Laryngoscope: Hyper-angulated laryngoscopes have a curved blade design that allows for a better view of the glottis without requiring as much movement of the patient's head and neck. They are often used in difficult airway situations. Sizes of Video laryngoscopes Video laryngoscopes are available in different sizes, typically measured by the size of the blade or the diameter of the insertion tube for hyper-angulated laryngoscopes. Common sizes range from pediatric to adult sizes. The use of oxygen during intubation with a video laryngoscope is similar to that of traditional laryngoscopes. Oxygen may be delivered through a nasal cannula or face mask at flow rates ranging from 5 to 15 liters per minute (L/min), depending on the patient's condition and oxygenation requirements. Uses of video laryngoscopes include endotracheal intubation in various clinical settings, including operating rooms, emergency departments, and intensive care units. They are particularly useful in cases of difficult airways or when direct laryngoscopy is challenging. Indications for using video laryngoscopes include anticipated difficult airway management, limited mouth opening, restricted neck mobility, and other factors that may hinder visualization of the vocal cords with traditional laryngoscopy. Contraindications to using video laryngoscopes may include patients with upper airway trauma, cervical spine instability, or those with a contraindication to tracheal intubation. Complications of video laryngoscopy are rare but may include dental or soft tissue trauma, laryngeal trauma, and airway injury. Proper technique, patient assessment, and ongoing monitoring are essential to minimize these risks. Video laryngoscopes are valuable tools in airway management, providing improved visualization and facilitating successful intubation in challenging clinical scenarios.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 10 Jet Ventilation Equipment Jet ventilation equipment, also known as high-frequency jet ventilation (HFJV), is a type of mechanical ventilation used in certain surgical procedures and emergency airway management situations. It delivers small, rapid bursts of gas to the patient's lungs, allowing for adequate oxygenation and ventilation. Jet ventilation equipment can be classified based on various factors such as the method of gas delivery and the intended use. Common types include: Types of Jet Ventilator 1. High-Frequency Jet Ventilator: This type of equipment uses a jet of gas (usually oxygen) delivered through a small catheter or cannula inserted into the patient's  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ airway, typically through the cricothyroid membrane. The rapid bursts of gas create oscillations in airway pressure, facilitating gas exchange in the lungs. 2. Manual Jet Ventilator: Manual jet ventilators are handheld devices used by healthcare providers to manually deliver gas to the patient's airway in emergency situations. They are typically used when other ventilation methods are not feasible or have failed. Sizes of Jet ventilation Jet ventilation equipment is available in various sizes, with different catheter or cannula sizes designed to accommodate different patient populations and airway sizes. Sizes may be labeled or marked for easy identification. The ideal oxygen flow rate and concentration during jet ventilation depend on the patient's condition and oxygenation requirements. Oxygen is typically delivered at high flow rates (e.g., 10-15 liters per minute) to ensure adequate oxygenation during jet ventilation. Uses of jet ventilation include providing temporary ventilatory support during certain surgical procedures (e.g., laryngeal surgery, tracheal resection) and emergency airway management situations where conventional ventilation methods are not feasible or have failed. Indications for jet ventilation include situations requiring precise control of ventilation, such as procedures involving the upper airway or where there is a risk of barotrauma with traditional ventilation methods. Contraindications to jet ventilation may include patients with severe lung disease, pneumothorax, or conditions where positive pressure ventilation may exacerbate underlying pathology. Complications of jet ventilation may include barotrauma (e.g., pneumothorax, pneumomediastinum), subcutaneous emphysema, hypoxemia, and respiratory acidosis. Proper technique, patient assessment, and monitoring are essential to minimize these risks. Jet ventilation equipment is a valuable tool in airway management, providing precise control of ventilation in certain clinical scenarios.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 11 ECG Machines The electrocardiogram (ECG) device is a vital tool in the intensive care unit (ICU) for continuously monitoring the electrical activity of the heart in patients. Here's an overview of its function, advantages, and disadvantages: Function of the ECG Device in the Intensive Care Unit: 1. Continuous Monitoring: The ECG device continuously records the electrical impulses generated by the heart, providing real-time information on heart rate, rhythm, and any abnormalities. 2. Early Detection of Cardiac Changes: It helps in the early detection of cardiac arrhythmias, ischemia, myocardial infarction, conduction abnormalities, and other cardiac conditions that may require immediate intervention. 3. Assessment of Treatment Response: It allows healthcare providers to assess the effectiveness of treatments such as medications, defibrillation, and pacing, by monitoring changes in the ECG waveform following interventions. Advantages of the ECG Device:  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 1. **Continuous Monitoring:** Provides continuous, real-time monitoring of cardiac activity, enabling prompt detection of any abnormalities or changes in heart rhythm. 2. **Rapid Assessment:** Allows for rapid assessment of cardiac status and response to treatment, facilitating timely intervention and management of cardiac emergencies. 3. **Guidance for Treatment:** Helps guide treatment decisions by providing objective data on heart rate, rhythm, and conduction abnormalities, aiding in the selection of appropriate therapies. 4. **Non-invasive:** The ECG procedure itself is non-invasive and does not pose any significant risk to the patient, making it a safe monitoring tool for critically ill patients. Disadvantages of the ECG Device: 1. **False Alarms:** The ECG device may generate false alarms due to artifact or minor irregularities in the ECG waveform, leading to unnecessary interventions or alarm fatigue among healthcare providers. 2. **Limited Information:** While the ECG provides valuable information about cardiac rhythm and conduction, it may not provide a comprehensive assessment of overall cardiac function or hemodynamic status. 3. **Dependency on Technical Factors:** Accuracy and reliability of the ECG readings may be affected by technical factors such as electrode placement, patient movement, or electrical interference, leading to potential inaccuracies in interpretation. Summary: The ECG device plays a crucial role in the intensive care unit by providing continuous monitoring of cardiac activity, facilitating early detection of cardiac abnormalities, guiding treatment decisions, and assessing treatment response. While it offers numerous advantages in terms of real-time monitoring and rapid assessment, it also has limitations such as false alarms and dependency on technical factors that need to be considered during interpretation.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 12 Portable x Ray Machine Portable radiography (also known as mobile radiography) is frequently performed in hospitals when patients are too unwell to transport to the imaging department. However, most health facilities endeavor to perform "departmental films", as image quality tends to be inferior when performed with a mobile x-ray system 1. Indications Mobile examinations are requested on patients who are unable to leave the ward for example: intubated medical emergency infectious neutropenic requiring wall-suction Patient position Most often, this projection is conducted on patients who are unable to move on their own and the position will be as the patient is. Therefore inevitably, radiographs are often suboptimal as even a good quality AP projection cannot be done, let alone a PA chest. Radiographic views  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ chest radiography o AP view: ideally fully erect ▪ patient is sat up in bed o PA view ▪ patient standing or sitting holding the detector up, often done in situations where the patient is well enough to do this but unable to leave the ward i.e. infectious o supine view o prone view abdominal radiography o supine view o erect view pelvis radiography o AP view ▪ often performed in scenarios where patient is unable to be transported to the radiology department i.e. trauma, infectious Patient preparation Patients will most likely already be in a hospital gown. However, it is still important to check and remove any necklaces, Holter monitors, or ECG leads that cover the area of interest. In cases where ECG leads cannot be removed, they should be repositioned out of the field as much as possible. Pitfalls if poor radiographic technique is used, the patient's treatment plan may be affected, therefore great care must be taken in order to closely simulate x-rays taken in the imaging department Through-glass technique During the COVID-19 pandemic, portable radiography has become a heavily utilized form of medical imaging. To lessen staff exposure to infectious patients (and keep the machine clean) radiographers can x-ray through the glass of a patient's room with a slight increase to the mAs for a similar (almost the same) image quality 2-5. Tips for portable radiography  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ planning how to x-ray the patient before moving the patient will keep the patient comfortable for as long as possible, thus may increase patient compliance ensure that surrounding staff and patients are not pregnant; if a nearby patient is pregnant, staff will need to move them away temporarily advise all staff and patients to stand as far away as possible during exposure as doubling the distance will halve the scattered radiation dose 1 before making an exposure, always produce an audible alert (i.e. "X-ray, Bed number _") to ensure all staff and patients nearby know an x-ray is about to be performed to maintain infection control, pillowcases or plastic bags can be used to cover the detector, and sanitizer wipes used to clean the equipment in between patients 13 Infusion (Syringe) Pumps Types of Infusion (Syringe) Pumps 1. Syringe Infusion Pumps: Functions: Deliver medication or fluids from a syringe at a controlled rate. Indications: Used for precise and controlled infusion of medications, particularly in critical care or anesthesia settings. Contraindications: May not be suitable for large-volume infusions or continuous fluid administration. Advantages: Precise control over infusion rate, compatible with various syringe sizes.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Disadvantages: Limited capacity for large-volume infusions, may require frequent refilling. 2. Volumetric Infusion Pumps: Functions: Deliver fluids from a reservoir bag or bottle at a specific flow rate over a set period. Indications: Used for continuous or intermittent infusion of fluids, medications, or parenteral nutrition. Contraindications: Not suitable for medications or fluids that require precise dosing or rapid administration. Advantages: Can accommodate large-volume infusions, programmable for different infusion rates and volumes. Disadvantages: May be less accurate at low flow rates, requires careful monitoring to prevent over-infusion. 3. PCA (Patient-Controlled Analgesia) Pumps: Functions: Allow patients to self-administer pain medication with a preset dose and lockout interval. Indications: Used for postoperative pain management or acute pain control in hospitalized patients. Contraindications: Not suitable for patients unable to understand or operate the device, or those at risk of respiratory depression. Advantages: Provides pain relief on-demand, reduces the need for frequent nurse- administered doses. Disadvantages: Requires patient cooperation and understanding, risk of overdose if not used correctly. 4. Enteral Infusion Pumps: Functions: Deliver nutrition or medications directly into the gastrointestinal tract via a feeding tube. Indications: Used for enteral feeding in patients unable to eat orally or absorb nutrients adequately. Contraindications: Not suitable for patients with intestinal obstruction or severe gastrointestinal dysfunction. Advantages: Ensures precise delivery of enteral nutrition or medications, reduces the risk of aspiration. Disadvantages: Risk of tube dislodgement or occlusion, requires frequent monitoring for complications.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 5. Insulin Infusion Pumps: Functions: Deliver insulin continuously at a basal rate, with additional bolus doses for meals. Indications: Used for intensive insulin therapy in patients with diabetes mellitus. Contraindications: Not suitable for patients who are not motivated or able to manage their diabetes regimen. Advantages: Provides precise insulin dosing, reduces the risk of hypoglycemia, offers flexibility in insulin administration. Disadvantages: Risk of pump malfunction or infusion site complications, requires regular monitoring and maintenance. Summary: Each type of infusion pump has specific functions, indications, contraindications, advantages, and disadvantages. The choice of pump depends on the patient's condition, the type of therapy required, and the setting in which it will be used. Healthcare providers must carefully assess the patient's needs and closely monitor the infusion process to ensure safe and effective treatment.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ ‫‪ICU Medical Disposable‬‬ ‫‪Instruments‬‬ ‫‪14‬‬ ‫‪Stethoscope‬‬ ‫‪15‬‬ ‫‪Manual BP Apparatus‬‬  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 16 Reducing valves Also called water pressure regulators, water pressure reducing valves are compact, inexpensive valves that perform two functions: 1. They automatically reduce the high incoming water pressure from the city mains to provide a lower, more functional pressure for distribution in the home. 2. They "regulate" by maintaining a set pressure in the home usually 50 lbs. thereby ensuring that the home piping and appliances operate under a safe, more moderate, but satisfactory pressure. Functions of Pressure Reducing Valves A pressure-reducing valve is able to control pressure through the fully automatic self- contained operation without the necessity of an external power source. The main functions of a pressure-reducing valve are: In steam systems, pressure-reducing valves are used to get precise control of downstream pressure. These valves automatically adjust the valve opening and adjust the pressure to keep it constant during pressure fluctuations. Properly selected pressure-reducing valves can be used for water hammer protection under defined conditions.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ They can also be used as bypass valves for saving the system during power failures. Pressure-reducing valves are capable of taking rapid action by immediate sensing and adjusting based on the downstream pressure. Types of Pressure Reducing Valves A pressure-reducing valve in a steam system works by balancing the steam pressure with a spring. Most of the modern pressure-reducing valves are manufactured using this basic concept. Based on the mechanism of controlling the valve opening, pressure-reducing valves are classified into two types: 1. Direct acting pressure reducing valve. 2. Pilot-operated pressure-reducing valve. Direct-acting pressure-reducing valve: Direct-acting pressure-reducing valves are ideal for small loads where precise pressure control is not required. They are manufactured in a compact size, cheap, and very easy to install. However, they usually have more variation from the set pressure as compared to their pilot-operated counterpart. Pilot Operated pressure reducing valve: Pilot-operated pressure-reducing valves are normally used for larger loads requiring close pressure control. They provide a faster response to load variation and are suitable for a wider range of flow rates as compared to the direct-acting types. They are larger in size and costly. There are two types of pilot operated pressure reducing valves: Internally piloted piston operated that incorporates two valves-a pilot and main valve-in one unit. It provides an accuracy of +/- 5%. Externally piloted where double diaphragms replace the piston operator of the internally piloted design. this type of pressure-reducing valve provides an accuracy of +/- 1%. Advantages of Pressure Reducing Valves The main advantages of a pressure-reducing valve are: No requirement for an external power source. Separate measuring elements or feedback controllers are not required. Simple design with low cost. High reliability and easy maintainability External leakage and source of high friction are eliminated by the absence of stem packing. Fast response Pressure Reducing Valve vs Pressure Relief Valve The main differences between a pressure-reducing valve and a pressure-relief valve are  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 1.0 Pressure-reducing valves maintain almost constant pressure at the downstream side of the valve. So, this valve is used only to maintain or reduce the higher pressure. Whereas pressure relief valves are used to protect equipment and systems from high pressure when the system or equipment pressure exceeds the set limit. 2.0 Pressure-reducing valves operate continuously in the line whereas pressure-relief valves pop up only when the set pressure limit is exceeded. 3.0 In a pressure-reducing valve the pilot line senses the outlet pressure whereas in a pressure-relief valve the pilot line senses the inlet pressure. 4.0 In normal working conditions, the pressure-reducing valve will be in the open position but the pressure-relief valve remains in a closed position. 17 Oxygen Flowmeters Oxygen therapy and other medical procedures require a variety of different supplies and equipment items to be administered safely and effectively. One of the most important components is an oxygen Name flowmeter, a device used to measure the rate at which gas flows from one place to another. These meters are essential to ensure that patients receive an accurate supply of medical gas during medical procedures or oxygen therapy. Oxygen flowmeters are located either directly on the oxygen tank or are standalone devices that can be attached to gas cylinders or other gas- Function delivering devices. While there are several different types of gas flowmeters (discussed below), all work by using scientific principles to measure the changes in a liquid or gas as it flows from one area to another. Medical airflow meters are tools that measure the flow of medical gases from the dispensing device to the patient. They are most commonly found Indications on oxygen tanks and oxygen concentrators. Flowmeters measure pressure loss and are essential tools for ensuring that oxygen devices deliver an accurate prescribed flow of oxygen to a patient.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ There are two different types of flowmeters: liquid and gas. Each one measures flow differently using various technologies. Some of the most common sub-flowmeter types are: 1. Differential pressure Flowmeters These sensors use orifice plates, nozzles or tubes to measure pressure loss as gasses pass from one end to another. Higher pressure drops indicate higher flow rates. 2. Ultrasonic Flowmeters On this type of meter, a transmitter sends ultrasonic waves into a pipe and back to another sensor. The frequency of the waves is affected by the movement of the fluid within the pipe, which can allow a flow rate to be determined. 3. Coriolis Flowmeters This meter works via a vibrating tube. Changes in gas flow causes changes in vibration frequency, thus allowing an accurate flow measurement. 4. Thermal Flowmeters Thermal meters use heat to measure flow rate. Temperature sensors located on the outside of the meter track the temperature Types of the gas as it flows through the tube or pipe. 5. Electromagnetic Flowmeters These meters use electromagnetic coils to create a magnetic field which changes as fluids or gases pass through a pipe. These are best used for gases and liquids that can conduct electricity. 6. Floating element Flowmeters One of the simplest types of flowmeters, the floating element meter, uses a float encased in a pipe. The float moves up and down as fluids or liquids are forced inside the tube, generating differential pressure. These are suitable for most types of gases. 7. Vortex Time Flowmeters Vortex flowmeters use the von Karman effect principle to measure flow velocity. This principle states that the flow of a liquid or gas will create a vortex as it passes a bluff body (a surface on which the front area is flat and broad). The frequency of the vortices helps determine the flow rate. 8. Paddlewheel Flowmeters This flow wheel depends on a small wheel located inside the device. Gas or fluid passing through the pipe move the wheel. The flow rate is determined by the speed at which the wheel spins.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Oxygen flowmeters are either located on an oxygen tank or are removable devices. Choosing the right type of flowmeter depends on what application they are being used for. 18 Disinfectant Dispenser 19 Laryngoscopes Laryngoscopes are medical devices used to visualize the larynx and vocal Name cords during intubation or other procedures involving the airway. They are classified based on their design and the method of illumination. Endotracheal intubation used for mechanical ventilation, insertion of Function supraglottic airway devices, and visualization of the airway during surgical procedures.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ It need for airway management, such as in cases of 1. Respiratory failure, Indications 2. Cardiac arrest, or 3. Surgery requiring general anesthesia. In Patients with :- Contra- 1. cervical spine instability or indications 2. certain facial or upper airway injuries where manipulation of the airway could worsen the condition. 1. Macintosh Laryngoscope: The Macintosh blade has a curved shape and is widely used for direct laryngoscopy. It provides a good view of the glottis when properly positioned. 2. Miller Laryngoscope: The Miller blade is straight and is often preferred for pediatric patients or those with limited mouth opening. It provides better visualization of the epiglottis. 3. McCoy Laryngoscope: is a laryngoscope designed to elevate the epiglottis with its hinged Types tip and requires less neck movement during laryngoscopy. It is frequently used to facilitate tracheal intubation when the view of the glottic opening is restricted. The McCoy laryngoscope has been documented to be a useful tool for orotracheal intubation by improving Cormack and Lehane (CL) laryngoscopes view in anticipated difficult intubation with cervical spine injury compared to conventional laryngoscope 4. Video Laryngoscope: These laryngoscopes have a camera at the tip of the blade, which provides a magnified view of the airway on a screen. They can be useful in difficult airway situations. Laryngoscope blades come in various sizes, typically numbered from 0 to Sizes and Numbers 4 or 5, with larger numbers indicating larger blades. The appropriate size is selected based on the patient's age, size, and individual airway anatomy. 1. Dental or soft tissue trauma, 2. Laryngeal or tracheal injury, 3. Aspiration Complications 4. Hemodynamic changes such as bradycardia or hypotension. Proper technique and careful patient assessment can help minimize these risks.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 20 Supraglottic Airway Devices Supraglottic airway devices (SGAs) are medical devices used to manage the airway without the need for tracheal intubation. They sit above the glottis Name and provide a conduit for ventilation and oxygenation. SGAs are classified based on their design and intended use. airway management during anesthesia induction, emergency airway Function management in pre-hospital or in-hospital settings, and as an alternative to tracheal intubation in certain situations. 1. situations where tracheal intubation may be challenging or not feasible Indications 2. in patients with difficult airways. 3. in patients with during rapid sequence induction. Contra- 1. patients with upper airway obstruction. indications  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 2. patients with esophageal pathology. 3. patients at risk of regurgitation and aspiration. 1. Laryngeal Mask Airway (LMA): The LMA is a widely used SGA consisting of an inflatable mask that sits in the hypopharynx, creating a seal around the laryngeal inlet. 2. ProSeal Laryngeal Mask Airway (PLMA): Similar to the LMA, the PLMA includes an additional esophageal drainage tube to reduce the risk of gastric insufflation and aspiration. 3. Intubating Laryngeal Mask Airway (ILMA): The ILMA is designed to facilitate tracheal intubation through the laryngeal mask airway, combining the benefits of both devices. 4. i-gel airways: Types The i-gel airway is used for the following purposes: Securing and maintaining a patient airway in routine and emergency anesthetics of fasted patients. During spontaneous or Intermittent Positive Pressure Ventilation (IPPV). During resuscitation of the unconscious patient. As a conduit for intubation under fiberoptic guidance (only sizes 3, 4, and 5) in known or unexpectedly difficult intubation. It is suitable for use by personnel who are trained and experienced in airway management techniques and devices SGAs come in various sizes, typically ranging from small to large, with specific sizes designed for adult, pediatric, and infant patients. The Sizes and Numbers appropriate size is selected based on the patient's weight, age, and airway anatomy. Sizes of Laryngeal Mask Airway (LMA) Range from size 1 to size 5 1. inadequate ventilation or oxygenation. 2. aspiration. 3. airway obstruction. 4. pharyngeal or laryngeal trauma. Complications 5. device displacement. Proper selection, insertion technique, and ongoing monitoring are essential to minimize these risks. 5. Laryngeal Mask Airway (LMA) ProSeal Laryngeal Mask Airway  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ ‫‪Intubating Laryngeal Mask‬‬ ‫‪i-gel airways‬‬ ‫‪Airway‬‬  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 21 Endotracheal Tubes The endotracheal tube (ETT) is a flexible plastic tube inserted through the Name mouth or nose into the trachea (windpipe) to establish and maintain an open airway. 1. Airway Management: Keeps the airway open and allows mechanical ventilation in patients who are unable to maintain adequate oxygenation and ventilation on their own. 2. Protection: Prevents aspiration of gastric contents into the lungs, Function reducing the risk of aspiration pneumonia. 3. Facilitation of Mechanical Ventilation: Allows for the delivery of positive pressure ventilation to support respiratory function in critically ill or anesthetized patients.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 4. Suctioning: Allows for the removal of secretions or debris from the airway to maintain patency. 4. Respiratory failure requiring mechanical ventilation (e.g., acute respiratory distress syndrome, coma). 5. Surgery requiring general anesthesia. Indications 6. Airway protection in patients at risk of aspiration (e.g., decreased level of consciousness, trauma). 7. Severe respiratory distress or impending respiratory failure. 4. Presence of upper airway obstruction preventing tube insertion. Contra- indications 5. Facial trauma or severe head injury. 6. High risk of aspiration with unprotected airway. 1. Cuffed Endotracheal Tube: Has an inflatable cuff that seals the trachea, reducing the risk of aspiration and minimizing air leak. 2. Uncuffed Endotracheal Tube: Lacks an inflatable cuff and is commonly used in pediatric patients or in Types situations where cuff inflation is not desired. 3. Reinforced Endotracheal Tube: Contains an additional layer of material (e.g., wire coil) to prevent kinking and maintain patency. 4. Double-Lumen Endotracheal Tube: Used in thoracic surgery to allow selective ventilation of each lung. Endotracheal tubes come in various sizes to accommodate different patient populations and clinical needs. Commonly, endotracheal tubes are available in sizes ranging from 2.0 mm to 10.0 mm internal diameter (ID) for neonates, infants, children, and adults. The specific size selected depends on factors such as the patient's age, weight, sex, and clinical condition. For example, smaller tubes are typically used for pediatric patients, while larger tubes are used for adult patients. The healthcare Sizes and Numbers provider will choose the appropriate size based on their assessment of the patient's airway anatomy and ventilation requirements. Endotracheal tube sizes are measured in millimeters (mm) or internal diameter (ID) in millimeters or French (Fr). Common sizes range from 6.0 mm to 9.0 mm for adult patients, with smaller sizes for pediatric patients. The number of endotracheal tubes required depends on the patient's condition and the procedure being performed. 1. Trauma: May cause damage to the vocal cords, tracheal mucosa, or surrounding structures during insertion. Complications 2. Displacement: Tube migration can lead to inadequate ventilation or accidental extubation.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 3. Infection: Risk of ventilator-associated pneumonia or other respiratory infections. 4. Cuff-related complications: Overinflation can cause pressure injury to the tracheal mucosa, while underinflation can lead to aspiration. 5. Ventilator 6. Barotrauma 7. Volutrauma 8. ventilator-associated lung injury Uncuffed Endotracheal Tube Cuffed Endotracheal Tube Reinforced Endotracheal Tube Double-Lumen Endotracheal Tube  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 22 Bougie devices are flexible, slender instruments used in airway management to assist with tracheal intubation, particularly in difficult Name airway situations. They are classified based on their design and composition Uses of bougies include 1. Assisting with tracheal intubation by guiding the endotracheal tube Uses through the vocal cords. 2. Providing tactile feedback. 3. Enhancing visualization of the airway structures. Indications for using bougies include 1. Difficult airway situations, such as limited mouth opening, restricted Indications neck mobility, or 2. Anatomical abnormalities that make direct laryngoscopy challenging. Contraindications to using bougies may include Contra- indications 1. Patients with known or suspected airway trauma. 2. Those with a contraindication to tracheal intubation. 1. Rigid Bougie: Made of rigid material such as plastic or metal, these bougies provide firm support during intubation attempts and are suitable for use in patients with a known or anticipated difficult airway. Types 2. Flexible Bougie: These bougies are more flexible, allowing for easier navigation through anatomical structures, particularly in patients with challenging airway anatomy.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ Bougies are available in various sizes, typically ranging from 10 to 15 Sizes and French, with larger sizes providing more rigidity and smaller sizes offering Numbers greater flexibility. The appropriate size is selected based on the patient's age, size, and airway anatomy. Complications of bougie-assisted intubation may include 1. Esophageal intubation, 2. Laryngeal trauma, and Complications 3. Mucosal injury. Careful technique and proper patient assessment are essential to minimize these risks. Bougies are valuable adjuncts in airway management, particularly in challenging clinical scenarios. Rigid Bougie Flexible Bougie 23 Stylets Stylets are rigid or semi-rigid devices used in airway management to assist Name with tracheal intubation. They are typically classified based on their design and composition. Uses of stylets include assisting with tracheal intubation by providing Uses shape and rigidity to the endotracheal tube, facilitating passage through the vocal cords, and enhancing visualization of the airway structures. Indications for using stylets include difficult airway situations, such as Indications limited mouth opening, restricted neck mobility, or anatomical abnormalities that make direct laryngoscopy challenging. Contraindications to using stylets may include patients with known or Contra- indications suspected airway trauma or those with a contraindication to tracheal intubation 1. Rigid Stylet: Made of rigid material such as metal or plastic, these Types stylets provide firm support to the endotracheal tube during intubation attempts, aiding in shaping and directing it through the vocal cords.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 2. Flexible Stylet: These stylets are more flexible, allowing for easier navigation through anatomical structures, particularly in patients with challenging airway anatomy. Stylets come in various sizes, typically ranging from adult to pediatric Sizes and sizes, with specific sizes designed for different age groups and airway Numbers sizes. The appropriate size is selected based on the patient's age, size, and airway anatomy. Complications of stylet-assisted intubation may include esophageal intubation, laryngeal trauma, and mucosal injury. Careful technique and Complications proper patient assessment are essential to minimize these risks. Stylets are valuable tools in airway management, particularly in challenging clinical scenarios. Rigid Stylet Flexible Stylet 24 Magill Forceps Name Magill forceps are angled forceps used to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision. They are also used to remove foreign bodies. These forceps are named after the Irish-born anesthetist Ivan Uses They are also used to 1. Remove foreign bodies  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 2. Placing pharyngeal packs (e.g. bleeding) 3. Aiding gastric tube passage into the oesophagus 4. Aiding passage of an endotracheal tube into the larynx (e.g. nasal intubation) Function and The primary function of Magill Intubation Forceps is to provide Application medical practitioners with a means to guide tubes or devices safely through the patient’s airway. This becomes particularly crucial in scenarios where traditional direct laryngoscopy might not provide optimal visibility or access. Magill forceps are commonly used when dealing with patients who have limited mouth opening, anatomical variations, or when intubation needs to be executed with precision, such as in pediatric cases. These forceps allow for delicate manipulation, reducing the risk of trauma to sensitive structures in the airway. Advantages and Magill Intubation Forceps offer several advantages, such as their Limitations versatility in navigating challenging airway anatomy, the ability to precisely guide tubes, and reduced risk of trauma. However, they might be limited in cases of limited mouth opening, significant airway obstructions, or when patients present with abnormal anatomy that requires specialized techniques. Technique and Using Magill Intubation Forceps effectively requires a systematic Procedure approach. Here’s a step-by-step guide: Preparation: Ensure the patient is properly positioned and anesthetized. Have the endotracheal tube ready for insertion. Insertion: Gently insert the Magill forceps into the patient’s mouth, following the curvature of the palate. The curved tips of the forceps should be directed posteriorly. Grasping: Locate the tip of the endotracheal tube within the patient’s airway. Use the Magill forceps to grasp the tube securely. Maneuvering: Carefully manipulate the forceps to guide the endotracheal tube through the vocal cords and into the trachea. Confirmation: Confirm proper tube placement using appropriate methods, such as chest auscultation and end-tidal CO2 monitoring. Safety While using Magill Intubation Forceps, safety remains paramount. Considerations Ensure the forceps are in good working condition and properly sterilized. Careful manipulation is essential to prevent injury to delicate tissues. Avoid excessive force or sudden movements that  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ could harm the patient’s airway. Always have backup plans in case intubation becomes difficult or fails. Comparisons In comparison to direct laryngoscopy or video laryngoscopy, Magill with Other Intubation Forceps provide a tactile advantage and finer control. Intubation They are particularly useful in cases where visual access might be Techniques limited, making them a valuable tool in a medical professional’s toolkit Magill Forceps 25 Guedel Airways Oropharyngeal airways (OPAs) Oropharyngeal airways (OPAs) are medical devices used to maintain the patency of the upper airway by preventing obstruction of the Name tongue and soft tissues during unconsciousness or sedation. They are typically classified based on their design and intended use. 1. Guedel Airway: The Guedel airway is a curved, rigid plastic device with a flange at one end and a hollow central lumen. It is available in various sizes, typically color-coded for easy identification of different sizes. Types 2. Berman Airway: Similar to the Guedel airway, the Berman airway is also curved and rigid but may have a more anatomically shaped design with flanges to better conform to the curvature of the palate. It may also be color-coded for size identification. OPAs are available in different sizes, usually ranging from small to large, Range from size 0 to size 5 , with specific sizes designed for adult, pediatric, and infant patients. Each size is often color-coded for quick identification: Sizes - Small: Typically used for infants and small children, color-coded in blue or another designated color. - Medium: Suitable for older children or small adults, often color- coded in white or another designated color.  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ - Large: Designed for larger adults, commonly color-coded in orange or another designated color. Uses of OPAs include maintaining airway patency during anesthesia Uses induction, sedation, or unconsciousness, particularly in patients at risk of airway obstruction due to decreased consciousness or muscle tone. Indications for using OPAs include situations where the patient is Indications unconscious or sedated and at risk of airway obstruction due to relaxation of the tongue and soft tissues of the oropharynx Contraindications to using OPAs may include patients with an intact Contra- gag reflex, those at risk of aspiration, or those with facial or upper indications airway injuries where manipulation of the airway could worsen the condition. Complications of OPAs may include gagging, vomiting, laryngospasm, oropharyngeal trauma, and obstruction of the upper airway. Proper selection, insertion technique, and ongoing monitoring are essential to Complications minimize these risks. OPAs are valuable tools in airway management, particularly in maintaining airway patency during unconsciousness or sedation. Guedel Airway Berman Airway 26 Nasopharyngeal Airways Name Nasopharyngeal airways (NPAs) are medical devices used to maintain the patency of the upper airway by preventing obstruction of the nasopharynx. They are typically classified based on their design and intended use. Types 1. Soft Nasopharyngeal Airway: These NPAs are made of soft, flexible material such as silicone or rubber, allowing for comfortable insertion into the nasal passages. They have a hollow central lumen to facilitate airflow. 2. Rigid Nasopharyngeal Airway: Rigid NPAs are made of stiff plastic or metal, providing more structural support to maintain the  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ airway patency. They may be useful in cases where soft NPAs are ineffective or contraindicated. Sizes NPAs are available in different sizes, usually ranging from small to large, Range from 6.0 mm to 9.0 mm ID , with specific sizes designed for adult, pediatric, and infant patients. Each size may be color-coded for quick identification: - Small: Typically used for infants and small children, color-coded in blue or another designated color. - Medium: Suitable for older children or small adults, often color- coded in white or another designated color. - Large: Designed for larger adults, commonly color-coded in orange or another designated color. Uses Uses of NPAs include maintaining airway patency during anesthesia induction, sedation, or unconsciousness, particularly in patients at risk of airway obstruction due to decreased consciousness or muscle tone. They are also commonly used in pre-hospital and emergency settings. Indications Indications for using NPAs include situations where the patient is unconscious or sedated and at risk of airway obstruction due to relaxation of the nasopharyngeal tissues. Contra- Contraindications to using NPAs may include patients with severe nasal indications trauma, nasal obstruction, or suspected basilar skull fracture. Complications Complications of NPAs may include epistaxis (nosebleed), mucosal trauma, gagging, or vomiting. Proper selection, insertion technique, and ongoing monitoring are essential to minimize these risks. NPAs are valuable tools in airway management, particularly in maintaining airway patency during unconsciousness or sedation, and when oropharyngeal airways are not suitable or tolerated. Soft Nasopharyngeal Airway Rigid Nasopharyngeal Airway  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ 27 Oxygen Face Masks Name Face masks are medical devices used to deliver oxygen or other gases to patients with respiratory insufficiency or respiratory failure. They are typically classified based on their design, intended use, and the method of oxygen delivery. Types 1. Simple Face Mask: This mask covers the nose and mouth and is held in place with an elastic strap. It delivers a low to moderate flow of oxygen, typically between 5 to 10 liters per minute (L/min). The oxygen concentration delivered by a simple face mask ranges from 35% to 60% at flow rates of 5 to 10 L/min. 2. Venturi Mask: The Venturi mask delivers a specific oxygen concentration by mixing oxygen with room air through a series of valves and adapters. Different colored Venturi adapters correspond to different oxygen concentrations, allowing for precise oxygen delivery. The oxygen concentration can range from 24% to 60% depending on the color of the adapter and the flow rate. 3. Non-Rebreather Mask: The non-rebreather mask has an attached reservoir bag that allows the patient to breathe in a higher concentration of oxygen. It has one-way valves to prevent the rebreathing of exhaled air. The oxygen concentration delivered by a non-rebreather mask is typically around 60% to 80% at flow rates of 10 to 15 L/min. Sizes Face masks are available in different sizes, usually ranging from small to large, with specific sizes designed for Neonatal, pediatric, small adult, medium adult, large adult patients. Each size may be color- coded for quick identification. Uses Uses of face masks include providing supplemental oxygen to patients with hypoxemia, respiratory distress, or respiratory failure. They may also be used during procedures requiring conscious sedation or anesthesia Indications Indications for using face masks include patients with hypoxemia, respiratory distress, or those requiring supplemental oxygen therapy to maintain adequate oxygenation. Contra- Contraindications to using face masks may include patients with severe indications facial trauma, burns, or those with a history of carbon dioxide retention. Complications Complications of using face masks may include skin irritation or pressure sores, discomfort, dryness of the nasal mucosa, and  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدمات الطبية والجودة‬ rebreathing of exhaled gases with certain mask types. Proper fitting, monitoring, and adjustment of the mask are essential to minimize these risks. Face masks are valuable tools in respiratory therapy, providing essential oxygenation support to patients with respiratory compromise. Venturi Mask Simple Face Mask Non-Rebreather Mask  ‫الجمهورية اليمنية‬ ‫وزارة الصحة العامة والسكان‬ ‫قطاع الخدمات الطبية‬ ‫إدارة الخدم