Critical care clinics
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In summary, the need to manipulate the airway in the pregnant patient requires careful consideration and substantial planning. Anatomic and physiologic changes of pregnancy, coexisting conditions, and the potential for aspiration all carry a risk of morbidity and, indeed, mortality. Preparation, including early and repeated airway evaluations throughout pregnancy and labor, is encouraged. ⋯ Equipment must be available and in good condition. Finally, proper education and review for individuals involved in the delivery of care on the labor floor are mandatory. Although it is not always possible to control the manner in which these patients present, it is usually possible to control the environment into which they present.
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Airway management in the pediatric patient requires an understanding and knowledge of the differences and characteristics unique to the child and infant. New and exciting techniques are currently being explored and developed for management of the pediatric airway. ⋯ Work continues to probe for methods and ways that will allow us to take care of infants and children better and to provide the safest and most effective means of delivering that care. No doubt, there will be more advances and exciting ideas to come that lead to better management of the pediatric airway.
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Patients who are difficult to intubate are randomly encountered. Patients who are in the postoperative period or who have suffered trauma have a greater chance of being difficult to intubate. The ability to quickly mobilize trained personnel and advanced equipment provides the best chance for a good outcome for these patients. Practice in placement of and intubation with LMAs is an important step toward providing an extensive safety net for patients needing intubation.
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Critical care clinics · Jul 2000
ReviewOrganization of personnel and resources for airway management in the hospital and office environment.
Good airway management depends on a system that emphasizes teamwork to expedite care and minimize errors. By understanding the accreditation and licensing requirements, appropriate personnel and equipment can be allocated along cost effective guidelines. Newer techniques for management of the difficult airway, such as the laryngeal mask airway (LMA; LMA North America, San Diego, CA) and flexible fiberoptic bronchoscope, provide alternatives to the emergency cricothyrotomy. A program of continuous quality improvement and clinical guidelines will enhance patient care and suggest intelligent use of airway resources.
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Critical care clinics · Jul 2000
ReviewBridges to establish an emergency airway and alternate intubating techniques.
In this article, a number of alternatives to direct laryngoscopy are examined. These alternatives include the laryngeal mask airway (LMA; LMA North America, San Diego, CA), cuffed oropharyngeal airway (COPA; Mallinckrodt, St. Louis, MO), and Combitube (Kendall-Sheridan, Mansfield, MA), that have been designed to act as bridges to establish an airway. Other devices, such as rigid stylets, the lightwand (a blind technique) and indirect fiberoptic rigid stylets, such as the Bullard scope, Upsher scope, and Wu scope are also briefly discussed.