Techniques for management of Diffcult Intubation
B.U.R.P.
this is applicable to a way to useful resource visualization of the larynx while the larynx lies caudal and anterior. It refers to the application :
Backward - to push the larynx backwards
Upward - to push the larynx as superiorly as viable
Rightward - no greater than 2cm
stress - to the thyroid cartilage (NB. now not the cricoid)
LARYNGEAL masks
This airway is the right emergency airway to be used by unskilled practitioners. It but does not provide airway safety and therefore in emergency situations need to only be seen as a temporary measure. In emergency situations it is able to be used as an airway in its own proper or as a song for the creation of an airway bougie or, in adults, for the insertion of a size 6 endotracheal tube.
method
▪ select the suitable size laryngeal masks
▪ in part inflate the cuff (this can make insertion simpler)
▪ Insert the masks into the pharynx with the distal aperture directed caudally till no resistance to in addition development is felt.
▪ absolutely inflate the cuff with air (10ml)
▪ try ventilation
▪ If insertion fails ie if the affected person can not be ventilated, deflate the cuff and withdraw the mask. Re-try the manner with the distal aperture to begin with directed cranially, then, once in the pharynx, rotate via a hundred and eighty stages as for an oropharyngeal tube.
If preferred, an airway bougie or an endotracheal tube may be exceeded via the lumen of the laryngeal mask into the trachea. This calls for masses of lubricant and can require a 90 degree rotation of the endotracheal tube to control it beyond the fenestrations within the aperture of the laryngeal masks.
complications
▪ Failed insertion
▪ Trauma to the pharynx
▪ Regurgitation and aspiration (the recorded incidence of this is low)
blessings
▪ simple
▪ easy to use
▪ fast
▪ almost foolproof
▪ offers not best an airway, however additionally a method of accomplishing a definitive airway
dangers
Does no longer find the money for airway protection and might result in gagging
AIRWAY BOUGIE
this is an extension of the concept of the introducer. a protracted piece of elastic cloth that's semi-inflexible can be directed into the trachea while it's miles not possible to acquire direct intubation due to an inability to peer the cords or due to difficulty in directing the endotracheal tube between the cords.
approach
▪ underneath direct imaginative and prescient the use of the laryngoscope the bougie is passed between the cords as to in which the cords are anticipated to be.
▪ the best sized endotracheal tube is then handed over the bougie and into the trachea the usage of the bougie to guide the tube
▪ If the tube appears to seize on the cords its development can be facilitated with the aid of twisting the tube through one hundred eighty ranges.
▪ The bougie is then eliminated, leaving the tube in area.
complications
▪ Failed intubation
▪ Trauma to the airway
▪ Oesophageal intubation
blessings
▪ Technically easy
▪ Avoids surgical tactics
hazards
can be awkward, especially if endotracheal tube gets snagged at the cords.
Backward - to push the larynx backwards
Upward - to push the larynx as superiorly as viable
Rightward - no greater than 2cm
stress - to the thyroid cartilage (NB. now not the cricoid)
LARYNGEAL masks
This airway is the right emergency airway to be used by unskilled practitioners. It but does not provide airway safety and therefore in emergency situations need to only be seen as a temporary measure. In emergency situations it is able to be used as an airway in its own proper or as a song for the creation of an airway bougie or, in adults, for the insertion of a size 6 endotracheal tube.
method
▪ select the suitable size laryngeal masks
▪ in part inflate the cuff (this can make insertion simpler)
▪ Insert the masks into the pharynx with the distal aperture directed caudally till no resistance to in addition development is felt.
▪ absolutely inflate the cuff with air (10ml)
▪ try ventilation
▪ If insertion fails ie if the affected person can not be ventilated, deflate the cuff and withdraw the mask. Re-try the manner with the distal aperture to begin with directed cranially, then, once in the pharynx, rotate via a hundred and eighty stages as for an oropharyngeal tube.
If preferred, an airway bougie or an endotracheal tube may be exceeded via the lumen of the laryngeal mask into the trachea. This calls for masses of lubricant and can require a 90 degree rotation of the endotracheal tube to control it beyond the fenestrations within the aperture of the laryngeal masks.
complications
▪ Failed insertion
▪ Trauma to the pharynx
▪ Regurgitation and aspiration (the recorded incidence of this is low)
blessings
▪ simple
▪ easy to use
▪ fast
▪ almost foolproof
▪ offers not best an airway, however additionally a method of accomplishing a definitive airway
dangers
Does no longer find the money for airway protection and might result in gagging
AIRWAY BOUGIE
this is an extension of the concept of the introducer. a protracted piece of elastic cloth that's semi-inflexible can be directed into the trachea while it's miles not possible to acquire direct intubation due to an inability to peer the cords or due to difficulty in directing the endotracheal tube between the cords.
approach
▪ underneath direct imaginative and prescient the use of the laryngoscope the bougie is passed between the cords as to in which the cords are anticipated to be.
▪ the best sized endotracheal tube is then handed over the bougie and into the trachea the usage of the bougie to guide the tube
▪ If the tube appears to seize on the cords its development can be facilitated with the aid of twisting the tube through one hundred eighty ranges.
▪ The bougie is then eliminated, leaving the tube in area.
complications
▪ Failed intubation
▪ Trauma to the airway
▪ Oesophageal intubation
blessings
▪ Technically easy
▪ Avoids surgical tactics
hazards
can be awkward, especially if endotracheal tube gets snagged at the cords.
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