Emergency medicine clinics of North America
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Cricothyroidotomy is a technique used to gain emergency access to the airway through the cricothyroid membrane. Although its use should be reserved for specific circumstances, the procedure is safe and can be performed rapidly. Knowledge of the anatomy of the anterior neck and a specific sequence for performing the cricothyroidotomy generally will result in a good success rate and acceptable complications.
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The esophageal obturator airway has been in use for the past 20 years. It is promoted as being easy to use and can be rapidly inserted blindly; however, numerous complications have been noted. The device is reviewed in this article and compared to endotracheal intubation.
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Emerg. Med. Clin. North Am. · Nov 1988
ReviewPharmacologic aids to intubation and the rapid sequence induction.
Endotracheal intubation usually can be performed in the emergency setting without the use of pharmacologic adjuncts. However, local airway anesthesia lessens patient discomfort, and the use of sedation and muscle relaxants occasionally may be necessary. Rapid sequence induction of general anesthesia adds benefits as well as risks to airway management; used in the circumstance of a full stomach combined with open eye injury or closed head injury associated with raised intracranial pressure, it should be practiced only by physicians appropriately trained and skilled at the procedure.
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Anatomically, the upper airway consists of the pharynx and nasal cavities. However, functionally, the larynx and trachea may be included, and the oral cavity provides an alternate entrance to the respiratory passages. The nose is a pyramidal structure composed of bone and cartilage attached to the facial skeleton, and is divided by a midline septum into the two nasal cavities. ⋯ The trachea extends from the lower edge of the cricoid cartilage to the carina where it divides into the mainstem bronchi. It is formed by U-shaped cartilaginous rings anteriorly and is closed posteriorly by the trachealis muscle. A properly placed endotracheal tube should have its tip at about midtracheal level.(ABSTRACT TRUNCATED AT 400 WORDS)