Emergency medicine clinics of North America
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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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In this article the author discusses standard oral, nasal, and surgical approaches to airway management, including some modifications of these routine techniques. Several specific clinical settings then are presented, and airway management options and recommendations for each condition are discussed. The clinical circumstances covered include blunt trauma, conditions causing elevated intracranial pressure, anterior neck trauma, problems of pediatric patients, and foreign body aspiration. A number of novel, unorthodox approaches to airway management also are presented.
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Relatively few emergency physicians are aware of the spectrum of regional anesthesia and the advantages it has to offer in the day-to-day practice of the specialty. Understanding the types of block and the principles that apply to neural blockade are only a beginning in the appropriate use of blockade techniques. A detailed knowledge of anatomy is essential to successful and safe practice; however, only repeated performance of the blocks will lead to predictable success!
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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)