wantitdone
Forum Newbie
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can u plz help me with criteria for intubation.Do u intubate any unconscious pt.In first aid mini cases,a young female with clear opiate intoxication[pin point pupils]with rr 8 was not intubated.An elderly male ,unconscious again with TCA intoxication rr 22 was intubated.Plz advice.
REF:First aid Minicases 11,12
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| drbcshah
Forum Elite
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Although intubation protects airway in unconscious
first step in opiate poisoning / alcohol intx if pt. Is breathing well is
iv thiamine + naloxone + dextrose
then see the response -- sos -- intubate
although in case of doubt -- intubate
other poisoning + unconscious --- intubate before gastric lavage.
Facial burns - intubate / cricothyroidotomy - depends on extent and time of presentation
head injury unresponsive or gcs < 7 --- intubate
facial trauma - sos nasotracheal vs endotracheal
Edited by new_n_lost on 02/07/08 - 10:52 AM. Reason: Changed the Font And PLZ AVOID BOLD FONTS
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| wantitdone
Forum Newbie
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thank you,drbcshah.that washelpful
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| lampard
Forum Newbie
Topics: 6
Posts: 30
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according to surgery notes :
In case of trauma :
intubate if : pt unconcious
or making gurgling breath sounds
or eminent subcut hematoma
or developing subcut emphysema
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| drbcshah
Forum Elite
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The American College of Emergency Physicians endorses the following principles regarding the confirmation of endotracheal tube placement in the emergency department or in the out-of-hospital setting.
* During intubation, direct visualization of the endotracheal tube passing through the vocal cords into the trachea constitutes firm evidence of correct tube placement, but should be verified with additional techniques.
* Verification of endotracheal tube placement should be completed in all intubated patients, and reconfirmation of endotracheal tube position should be done in all patients when their clinical status changes, or when there is any concern about proper tube placement.
* Standard physical examination methods, such as auscultation of lungs and epigastrium, visualization of chest movement, and fogging in the tube, are not sufficiently reliable to exclude esophageal intubation in all situations.
* Verification techniques include capnometry, esophageal detection devices, and revisualization with direct laryngoscopy.
* End-tidal CO2 detection, either qualitative, quantitative, or continuous, is the most accurate and easily available method to monitor correct endotracheal tube position in patients who have adequate tissue perfusion.
* Pulse oximetry and esophageal detector devices are not as reliable as end-tidal CO2 determinations in patients who have adequate tissue perfusion.
* For patients in cardiac arrest, and for those with markedly decreased perfusion, when end-tidal CO2 does not confirm tracheal intubation, other methods of confirmation, such as direct visualization, should be done.
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