Critical care clinics
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Critical care clinics · Jul 2000
ReviewAirway management and direct laryngoscopy. A review and update.
Direct laryngoscopy is the direct visualization of the larynx while using a rigid laryngoscope to distract the structures of the upper airway. This article reviews the anatomy relevant to laryngoscopy and then presents a stepwise approach to the procedure. Alternative intubation techniques, positioning, laryngoscopy blades, and stylets are then covered. Pharmacologic adjuncts are discussed briefly as they relate to the difficult airway and incorporation into overall airway management.
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Critical care clinics · Jul 2000
ReviewEmergent management of the airway. New pharmacology and the control of comorbidities in cardiac disease, ischemia, and valvular heart disease.
Once it is decided that the patient in distress requires tracheal intubation, the primary goal is to secure the airway as quickly and safely as possible to assure adequate oxygenation and ventilation. The clinician should quickly review the patient's history, physical examination findings, and laboratory data to determine the presence of cardiovascular disease, assess intravascular volume status, and formulate a plan for induction of anesthesia. The stresses of hypoxia, hypercarbia, acidosis, and extreme fatigue result in near-maximal sympathetic outflow that is manifest as tachycardia, labile blood pressure, and increased myocardial contractility. ⋯ Most clinical studies have been performed in hemodynamically stable patients, so the routine dosages of sedative hypnotics should be reduced substantially and titrated to effect. An additional strategy is to treat significant hemodynamic perturbations with vasopressors, vasodilators, short-acting selective beta-1 blockers, and inotropic agents. The choice of vasoactive agent depends on the magnitude of the hemodynamic response and the presence of specific underlying cardiovascular pathology.
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Critical care clinics · Jul 2000
ReviewTeaching airway management skills. How and what to learn and teach.
It is important to instruct all individuals involved in patient care in airway management. The degree of skills actually taught depends on the student. Currently, there are many options for teaching. ⋯ There is room for improvement in instruction, even in anesthesiology programs. Various techniques must be taught and practiced. As more anesthesiologists become trained and then train other physicians, the number of cases in the Closed Claims Study involving the airway will continue to decrease.
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Critical care clinics · Jul 2000
ReviewThe role of fiberoptic bronchoscopy in airway management of the critically ill patient.
Fiberoptic bronchoscopes (FOB) play a pivotal role in airway management in the operating room and critical care environments. This article examines the role of FOBs in modern airway management based on a review of recent literature and personal experience.
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Despite having been a known surgical procedure for over 5000 years, the specifics of how, when, and why to perform a surgical airway are still debated. With new procedures, equipment, and techniques, operative airway management is becoming more complex. ⋯ Unlike Dr. Jackson in 1909, surgeons today have to evaluate these new procedures not only by their efficacy but also by their cost effectiveness.