Articles: intubation.
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A case of delayed detection of esophageal intubation is described. Preoxygenation and pulse oximetry were used, and the first indication of tube misplacement was arterial desaturation indicated by the pulse oximeter. The combination of preoxygenation and pulse oximetry may contribute to delays in early detection of endotracheal tube misplacement for the following reasons: (1) preoxygenation results in a pulmonary reservoir of oxygen sufficient to maintain arterial hemoglobin saturation for an extended period of time; and (2) the maintenance of normal arterial saturations for an extended period after inadvertent esophageal tube placement may lead the practitioner to initially seek other causes of declining oxygen saturations. Although pulse oximetry is an acknowledged advance in patient monitoring, it must not be utilized as an early indication of correct endotracheal tube placement.
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Airway obstruction remains a constant problem in acute care. This is particularly true when there are anatomical or pathological abnormalities, trauma, or when repeated failed attempts at endoscopic or blind intubations have left a bloody field, preventing clear visualization of the vocal cords. Our refinement of translaryngeal guided intubation (TLI) uses a spring guidewire accompanied by a plastic sheath protector. ⋯ A well-lubricated endotracheal tube is then inserted to the desired position using the plastic sheath as a stylet. This technique works very well, and we are convinced that TLI is one of the most effective emergency techniques to secure an airway. It can be performed quickly with inexpensive equipment and is a promising addition to the currently recommended alternatives.
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J. Oral Maxillofac. Surg. · Sep 1987
Case ReportsBilateral fixation of a nasotracheal tube by transfacial Kirschner wires.
Because of the high margin for error with transfacial internal wire fixation, even in the hands of an experienced practitioner, alternative modalities in the treatment of zygomaticomaxillary complex fractures should be considered. When the use of transfacial rigid wire fixation is indicated, emphasis should be placed on prevention and early recognition of nasotracheal transfixation to avoid unnecessary postoperative catastrophies.
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Iatrogenic rupture of the stomach has been reported as a rare complication of nasopharyngeal oxygen therapy. A new case of this life-threatening condition is reported and diagnostic, therapeutic and preventive measures are briefly discussed.
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An exercise in quality assurance during neuroanaesthetic procedures identified uncontrolled re-use of armoured latex rubber tracheal tubes as a risk factor associated with equipment failure. We recommend that such tubes should be used once only. Alternatively, tubes made from more stable materials, such as polyvinyl chloride and silicone rubber, are available for clinical evaluation.