Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Maham Fazal
NC-785
Complications:
1. Upper airway trauma, sore throat, laceration of lips gums pharyngeal
mucosa
2. Laryngospasm, Bronchospasm 3. Perforation of trachea
4. Esophagus perforation 5. Esophageal intubation
6. Injury to vocal cords 7. Hoarseness
8. Laryngeal edema 9. Tachycardia HTN
Endotracheal Tube
• CUFF: Used in children above 6-8 years and adults (Pediatric are
uncuffed as trachea easily damaged by pressure)
Cuff Pressure: 20-25cm of water. It will burst if >30 cm of water. 5-
10ml air is injected usually
Types: high volume low pressure low volume high pressure
1. Seals the airway and prevents aspiration
2. Prevents leakage of air during ventilation so PPV can be given
3. Keeps tube in place
• Bevel: usually left facing. Allows easy visualization of vocal cords and
easy access into trachea
Contraindications:
1. Awake patients (with intact gag
reflex)
2. Foreign body obstructing airway
3. Severe coagulopathy
Oropharyngeal Airway
• Complications:
1. If patient is awake, gagging and vomiting
2. Damage to oral cavity, teeth
3. Obstruction of airway due to large size of tube
4. Bleeding due to improper size
• Parts:
Curved tube – curve upwards when placing then rotate inside mouth
(can be placed directly in children)
Flange – to keep it in place
Oropharyngeal Airway
Nasopharyngeal Airway
• Indications:
1. Conscious and semi conscious
patients
2. Intact gag reflex
3. People who are clenching
their teeth
4. Facilitate suctioning
5. Apply CPAP
6. Guide for fiberscope/ NGT
Nasopharyngeal Airway
• Contraindications:
1. Skull base fracture
2. Coagulopathy or patient taking Anti coagulation medications
3. Nasal fractures or any nasal pathology e.g. polyps
4. History of epistaxis requiring medical treatment
• Complications:
1. Epistaxis and aspiration of blood
2. Sinusitis
3. Injury to posterior pharyngeal wall
4. insertion through cribriform plate into brain
5. Ulceration, injury to nasal turbinates
Nasopharyngeal Airway
Laryngeal Mask Airway
• Indications:
1. Difficult airway
2. Guide/conduit for ETT
3. When ETT has failed
4. Elective ventilation
5. Pre-hospital setting
emergency airway
Laryngeal Mask Airway
• Contraindications
Absolute:
1. Inability to open the mouth/trismus
2. Complete upper airway obstruction
Relative:
1. Risk of aspiration
2. Suspected or known abnormalities of supraglottic region
3. Need for high airway pressures
• Complications:
1. Aspiration of gastric contents
2. Local irritation
3. Upper airway trauma, sore throat
4. Improper placement – obstruction, laryngospasm
5. Positive pressure ventilation – pulmonary edema, bronchoconstriction
Laryngeal Mask Airway
• Insert while patient is in sniffing position
Tracheostomy Tube
• Indications:
1. Respiratory obstruction
(infections, neck trauma,
neoplasm, foreign body, congenital
anomalies, laryngeal edema)
2. Retained secretions (inability to
cough)
3. Resp insufficiency (lung
conditions)
• Contraindications:
1. Laryngeal carcinoma
2. Coagulopathy
3. Cervical spine fracture
4. Morbid obesity with short neck
Tracheostomy Tube
• Immediate:
Intraoperative bleeding
Apnea
Pneumothorax Pneumomediastinum
Injury to recurrent laryngeal nerves, esophagus, great
vessels
• Early:
Bleeding
Tracheitis
Displacement
Blockade
Subcutaneous emphysema
• Late:
Bleeding
TEF
Tracheal stenosis
Tracheostomy Tube
• Types:
Cuffed with disposable inner cannula
Cuffed with reusable inner cannula
Cuffless with disposable/reusable inner cannula
Fenestrated cuffed/cuffless
Metallic
Bag Mask Ventilation
• Indications:
1. Resp failure
2. Failed intubation
3. Elective ventilation in GA
Contraindications:
1. Complete airway obstruction
2. Facial trauma eye injuries
3. Foreign body in airway
Complications:
1. Lung aspiration
2. Lung injury volutrauma barotrauma
3. Hyper/hypoventilation
4. Gastric insufflation
Bag Mask Ventilation
• Therapeutic:
1. Administration of medication
2. Feeding
3. Bowel irrigation
4. Gastric decompression
5. Aspiration of gastric contents
following toxic material ingestion
6. Relief of symptoms and bowel rest
in case of obstruction
Nasogastric Tube
• Contraindications:
Absolute: 1. Severe mid-facial trauma 2. Recent nasal surgery
• Relative: 1. Esophageal varices 2. Coagulopathies 3. Recent
esophageal banding
Complications:
1.Local trauma, irritation of throat and nose
2. Epistaxis
3. Aspiration
4. Respiratory tree intubation
5. Esophageal perforation
Nasogastric Tube
• Types:
Nasogastric Tube
• Complications:
1. Post LP headache 2. Post LP back pain 3. Bleeding 4. Infection
5. Cerebral herniation 6. Nerve injury 7. Hematoma 8. CSF leakage
Foley Catheter
• Indications:
1. Urinary retention (pass smaller
bore catheter first e.g. 12 F)
2. Bladder outlet obstruction e.g.
BPH, urethral stricture/stenosis
3. Urine output monitoring
4. Neurological bladder
dysfunction e.g spinal shock,
neurogenic bladder etc
5. Collection of sterile specimen
for diagnostic purposes
6. Instillation of medications,
chemotherapeutic agents
7. Imaging study of lower urinary
tract
Foley Catheter
• Contraindications:
1. Urethral trauma – blood at meatus, high riding prostate, bruising
2. Cautious in patients with urethral strictures
• Complications:
1. Urethral trauma
2. CA-UTIs
3. Leakage
4. Obstruction due to encrustation
5. Pyelonephritis
6. Renal and bladder calculi
7. Bacteremia
8. Fistula formation
Foley Catheter