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Endotracheal Tubes (ET), Intubation

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Please select from the following:

American Academy of Anesthesiologist Assistants: An Anesthesiologist Assistant (AA) is a person qualified by advanced education and clinical training to work cooperatively with an anesthesiologist in developing and implementing the anesthesia care plan.
http://www.anesthetist.org

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Removal of the Endotracheal Tube, AARC Clinical Practice Guideline, Respiratory Care (Respir Care 1999;44(1):85-90):"To ensure patient safety, the patient with a temporary, artificial translaryngeal airway should have the device removed at the earliest appropriate time. Occasionally, acute airway obstruction of the artificial airway due to mucus or mechanical deformation mandates immediate removal of the artificial airway. (This guideline pertains to the decision processes surrounding the removal of an artificial translaryngeal airway, and the procedure referred to as extubation.)"
http://www.rcjournal.com/online_resources/cpgs/rotetcpg.html

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Mishaps With Endotracheal Tube Exchangers In ICU: Two Case Reports And Review Of The Literature:"Recently, a surprising high failure rate exchanging endotracheal tubes has been noted by Mort et al. when using the oral approach (16). This preliminary report is the only study comparing two different ETTE found in a review of the literature using the keywords airway, exchanger, catheter, changer, endotracheal, intubation, extubation, difficult airway and fiberoptic bronchoscope with four different search engines (Grateful Med(r), Ovid(r), Healthgate Free Medline(r) and PubMed(r)) since1966 to date. The scarce information about complications of this type leads us to report the following cases."
The Internet Journal of Anesthesiology
Internet Scientific Publications LLC
23 Rippling Creek Drive
Sugar Land, Texas 77479
USA
Phone: (832) 443-1193
Fax: (281) 240-1532
E-mail: wenker@ispub.com
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol5n1/ette.xml

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Securing And Care Of Endotracheal Tubes (Ett's), medicineau.net.au:"STANDARDS: * All registered nurses and medical officers may secure and care for endotracheal tubes. Two people are required for this procedure. * The endotracheal tube will be secured in such a way as to maintain its desired position. * The cuff pressure of an endotracheal tube will be checked once a shift and prn. * The endotracheal tube will be secured in such a way as to prevent pressure sores from developing. * The endotracheal tube will be secured so as not to occlude the pilot tube."
http://www.medicineau.net.au/clinical/ICU/procedures/ettcare.html

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Endotracheal Intubation, What is the purpose of endotracheal intubation? medicinenet.com:"The endotracheal tube serves as an open passage through the upper airway. The purpose of endotracheal intubation is to permit air to pass freely to and from the lungs in order to ventilate the lungs. Endotracheal tubes can be connected to ventilator machines to provide artificial respiration."
MedicineNet, Inc.
903 Calle Amanecer, Suite 300
San Clemente, CA 92673
Telephone: 949.940.6500
Fax: 949.940.1094
http://www.medicinenet.com/endotracheal_intubation/article.htm

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Orotracheal Intubation, Indications, medstudents.com.br:"1. Inadequate oxygenation (decreased arterial PO2, etc.) that is not corrected by supplemental oxygen supplied by mask or nasal prongs. 2. Inadequate ventilation (increased arterial PCO2). 3. Need to control and remove pulmonary secretions (bronchial toilet)."
http://www.medstudents.com.br/proced/proced5/intubat.htm

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Diagrams, Illustrations:

The ASA Difficult Airway Algorithm:
http://www.metrohealthanesthesia.com/edu/airway/ASADifAirLMA.htm

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Discussion of Correct Sizing of Endotracheal Tubes (Pediatric), Virtual Children's Hospital:"Endotracheal tubes for children older than 8 years may have a low-pressure, high-volume cuff to help prevent leaking around the tube. Children younger than 8 years old should never have a cuff on the tube, as the cricoid cartilage itself serves as a functional cuff. Estimations of the correct size for an individual child older than 1 year may be made by using the formula: internal diameter of the tube = (16 + the age in years) divided by 4. Thus, a 2-year-old child would probably need a 4.5-mm internal diameter uncuffed tube."
http://www.vh.org/pediatric/provider/pediatrics/ElectricAirway/Discussion/DiscSizingETT.html

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Reference:

Management of Airway Emergencies, AARC Clinical Practice Guideline:"Management of airway emergencies (MAE) for the purpose of this guideline encompasses all care necessary to deal with sudden and often life-threatening events affecting natural and artificial airways and involves the identification, assessment, and treatment of patients in danger of losing or not being able to maintain an adequate airway, including the newborn. This includes (1) identification of the causes of airway emergencies; (2) management of airway emergencies prior to tracheal intubation; (3) use of adjunctive equipment and special techniques for establishing, maintaining, and monitoring effective ventilation; (4) translaryngeal tracheal intubation, including nasal and oral tracheal intubation; (5) transtracheal catheter ventilation, (6) percutaneous dilational cricothyrotomy, and; (7) surgical cricothyrotomy."
http://www.rcjournal.com/cpgs/maecpg.html

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New Airway's 'Smarts' Ensure That Patients Get Plenty Of Oxygen:"Endotracheal tubes are relied upon by thousands of doctors, surgeons, and ambulance crews every day, but today's devices sometimes do more harm than good. Amid distractions like sirens and flashing lights, dangerous debris, and the cries of victims, rescuers can actually cause life-threatening complications by unwittingly inserting the tube in a patient's esophagus rather than the trachea, sending oxygen to the stomach instead of the lungs. Most experts estimate this occurs in 2 to 5 percent of patients, though a few doctors have suggested that the problem is much more common. If they're not found and corrected, such errors can lead not only to insufficient ventilation but also to stomach rupture, airway trauma, irreversible damage to the heart or brain, or even death."
http://www.rochester.edu/pr/releases/ee/mottley.htm

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Last updated by Andrew Lopez, RN on Wednesday, January 30, 2013


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