Keywords: airway obstruction, anaesthetic techniques, fibreoptic intubation, neuromuscular blockingĪirway management has progressed since the first orotracheal intubation in 1878 using a blind digital technique.( 1) Since the 1940s, the Macintosh laryngoscope has allowed tracheal intubation under direct vision. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. If the breathing pattern or inspiratory volumes are inadequate to sustain life, rescue breathing will be required, and an advanced airway should be placed.Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. Some possible changes are apnea (cessation of breathing), irregular breathing patterns, or poor inspiratory volumes. If trauma, hypoxia, stroke, or any other form of injury affects this area, changes in respiratory function may occur. The breathing center that controls respirations is found within the pons and medulla of the brain stem. If neither technique works, attempt an advanced airway using inline stabilization. If the jaw-thrust proves unsuccessful in opening the patient’s airway attempt an oropharangeal or nasopharangeal airway. If there is a reason to suspect a cervical spine injury, if the patient’s adverse event went unwitnessed, if trauma occured, or the patient suffered drowning the jaw-thrust maneuver should be used to open the airway. If the adverse event of the patient was witnessed and there is no reason to suspect a cercival spine injury, the provider should use the head tilt-chin lift maneuver to open the airway. If the provider evaluates the patient to have an obstructed airway, intervention should take place. If the airway is partially obstructed snoring or stridor may be heard. The provider will also not feel or hear the movement of air. If the patient is attempting spontaneous breaths without success, there may be noticeable effort of intercostal muscles, diaphram, or other accessory muscles without significant chest rise/expansion. An awake patient will lose their ability to speak, while both a conscious or unconscious patient will not have breath sounds on evaluation. The provider may also be able to hear or feel the movement of air from the patient.Ī completely obstructed airway will be silent. If the airway is patent there should be noticeable chest rise/expansion with either spontaneous respirations or with rescue breaths. Second, is there possible injury or trauma that would change the providers method of treating an obstructed airway or inefficient breathing.
First, is the airway patent or obstructed.
There are two important principles when evaluating the airway and breathing.
0 kommentar(er)
