LAERDC'S VALVE

CSISH MOUTH VALVES

Ambulatory manual breathing

Unit(Astificial manual breathing unit

RESERVOIR:90-100%
BAG AND MASK VENTILATION selfi nflation
/
ci,

ii) Keep on palm, make

·volume:240-7S0m/ RVOIR:40-50%.
2 x a stal
Reservois POP. OFf CHILDREN:7S0m/
iii) popoff value

**
VALVE
1if+5
2s0m)
==>
weonates:

mask should cover the nose and mouth of

t he lady
-
D Response:↑ HR
·
Rate: 40 -
60/min
15t00e9th: 30-40cmH20

Subsequent:
↓
pressure:
15-20 mp20

INDICATIONS
·Recommended inflation
pressure:
No response PT:20cm420
Apheic / gasping
↓
·

·
HR <100 ·7:30cmH20

5,02700m
STEPS
CORRECTIVE ·

central
·persistent
Room ai5(21 y.)
:

cyanosis despite

I
m :m a s k
readjustment hate
preterm
100% Free HOW 02

R :Reposition head Preterm:st a r t with 30%

30%)
↓
(21
(<3SW/S)
-

S:suction
Titated with
a5ge + spOZ
+

0:openmouth

1min:00-65%.

p :pressure
3min:70.75%.
2 17:CDH A :Alternative Fxintubation
airway =
10min:85-95%.

Tell us whether the cuff is

inflated of deflated

Prevents Gisl0sS

2 0
+ facilitate
↑ 211:

ventilation of severe airway trauma

other sides
-
Inflating
tube
·cervical spine injury

S ⑧ T UBE
DUTTHE TILL

measure from
MARK 22-23

incisos)
Helps position the tip of
=> above the difurcation
trache a
of
How to check tube is in right place?

·Air dlast-Trached

Auscultation

5127

98
·
(HILD: u
+

4:7 7.5
·
-

05:7.5 -9

i. pPV

(ii) can be used in patients

in which radiation is

required

(iii) prevents aspiration

LARYNGEAL MASIC AIRWAY

suptaglottic airway device

small adult (130kg):3

⑫ ADUIT (30-70kg):Y

LARGER ADULT:S
 catheters
① Non -
self oetaining : simple seed oboes catheter

② self Detaining : Foley 's , malecot 's ,

Gibson's
[ Balloon tip Foley 's
[
:

Flower tip : Mal @ cot 's

[
Strapping catheter externally

foley 's
-
LATEX i kept Foo 7-
days
8 : BLACK

10 : 489g ① Two ways

12 : white ② 3 way : TURD

14 : Green ③ Silicone : ~ 3 MO

16 :
ooange
18 : Red

20 : Yellow

22 : Puople
24 :
Blue
16 f- = 16mm Circumference
L Diameter :
circumference
3-
uses : -

'
Retention of cosine

-
measure urine output

Cholecystotomy
-

-
TO doa in fistulas

.
Bedoidden patient

- Stroke

urinary incontinence

.
Central lesion / cooed lesion

. Renal failure

. Before [Link]
. EPISTAXIS

. Induction Of taboos

Into a vesical BCG ( Foo Bladd @ sconces

]
.

. Inflate with DISTILLED WATER

as if inflated with is = > it will float

 male uoethoa

.
18 -
20cm

•
prostatic , membranous ,
bulbao , penile

- ✗ oetenlon
m -
c site of injury ,

disease

: 4cm

•
↑ incontinence

① SIMPLE ( ✗ self retaining device)

Latex
Lpvc
-
TO doain bladders empty and remove

② with self sretaining devices ( Siaiislic / silver alloy/ antibiotic impregnated

LBIWAY :
Doainage and Balloon inflation Channel

( TRIWAY : Biwayt iooigalon Channel

CAUDE TIP
STRAIGHT TIP

- -
. 1 Fo : O -
33 inches diameter

Adults : 16 -18 Fo

obstruction Caud @
. + :
lip

CHILDREN :
n 8
t
-

. ( Gmo : Feeding tube ( Sf )

urine output 1-
: O S MI /
Kg / h2
- - -
 Indications
① Tooelieve ooinaoy obstruction
. Acute CBPH . Clots)

. Chronic
LCIC
Neurogenic bladder )

② TO monitor
urinary output

③ Afteosx

instill medication
④ to ( Bca )

⑤ supportive
-

Hygienic case of bedridden patients

-
to assist in immobilization

• to assist healing of an open social oo perineal wound

⑥ collection of uncontaminated urine specimen in

⑦ Imaging of
uoinaoytoact

TYPES

Indwelling

Intermittent ( CIC )

[Link]# Intermittent catheterization

( ✗ ASEPTIC )

CII
① Toaumalic injury to lowes uoinaoy toact

.
suspected in pelvic 00 Stoaddle type injury
•
Blood at meatus perineal hematoma . acute retention
,

.
PR : High siding prostate

② complicated lower UTI

long term voinaoy diversion

③
 . ✗ SPIRIT

• Povidone -
Iodine

.
2% LIDOCAINE Get

-
Plastic syoinge

Cx

① Bleeding

GROSS HEMATURIA

.
occurs in patients with chronic uoinaoy oetenlion

- Sudden decompression of bladder may cause oupNo @ of

small venule

② False passage

③ Paoapnimosis
④ Infection

. CAUTI

⑤ stoictooes
L BULBAR

⑥ Accidental oemoval

⑦ catheter blockage

⑧ Allergy to latex

⑨ Bladder stones
 NASOGASTRICTUB

8:B1aCK

10:980y

12:White

17:a0een

16:Orange

18: Red

20:Yellow

22:people

24:Blue

feeding tube
Infant
·
cap a end #
+ .
RADIOPAQUELINE ④

XOPENING ATSIDE XOPENING ATTIP

SUCTION CATHETER
x
cap a end
· +

·opening atside #

· LINE
XRADIOPAQUE

·OPENING AT 1P #
 ( DUODENUM )

C BODY OF
( PYLORUS )
GET

STOMACH)
 RYLE 'S TUBE

- 125cm -
OPENING OF ESOPHAGUS =) GULLET

INDICATIONS

① Todoaingastoic contents

-
Intestinal obstruction

-
major abdominal SX

Rxgastoic immobility
-
toauma

② obtain a specimen

-
pH

-
at bleeding
-
GASTRIC LAVAGE → TB

③ Doug Oveodose ,
poisoning
Ice cold NS - Gastric
bleeding
① Enteral feeding / dougs

PVC polyurethane/ silicone

§
• ""° •
ˢ°"

-
Cheap -
costly

Upto GWKS
2. wks
Upto
.

§
• ↑ complications . less complications

stomach decompression ,
Enteral feeding
lavage , post op ,

diagnostic

WIDE BORE : Doa

image ( 16-18 f- 8)
.
/
-
Fines ( < 9F8 )
:
Feeding

children -

4-15 franch
Adult -
16-18 French -
 SIZE

Agez

" °" °"

÷
U

. Directed bostesiooly

. confirm if tube coils in mouth

 CONFIRMATION when to take out ?

Puoposeisoveo
< 100 -150Mt
① Aspirate .

Output :

•
Bile stained .
Bowel sounds ⊕

.
Clear -
PMCS =) GASTRIC

② Auscultate ( afters injecting aio)

. Gush of aio into stomach . Pinch tube

-
Heard in the stomach . Slow /
Steady motion

③ X -
RAY

C /I

Facial trauma Base of skull#

.
# Nose . ,

2
ORO GASTRIC TUBE

-
corrosive poisoning
varices
. Obstructed esophagus , esophageal

-
obstructed airway

. Clotting disoodeos

cx : -

.
Epistaxis

rashes
-
Bleeding Foom

Pneumonitis
-
Aspiration

.
Reflux

.
sinusitis / Rhinitis

.
Displacement
-
Erosion of nose . nasal Ulc@ 09170h

. intracranial placement

. intoaooonchial placement
 STROBOSCOPY > flashes of
=
light as@ shone on the
moving vocal cords which will make the

( movement of

>
VC appease slow in the form of waves
,

Done Foo small lesions

DIRECT LARYNGOSCOPY

① DIRECT

② SUSPENSION

③ MICROSCOPIC

INDICATIONS

-
Children : hoarseness , stsidoz , dyspnea

possible epiglottis
I / Lnot
overhanging
-
,

Subg / Ottis Apex of PF , Postcsicoid

ventricle , ,
•
Hidden asreas ( Lazying @ a) suoface epiglottis ,
.

Anteoioo commisuoe )
Extent of growth
-

-
LARYNGEAL TRAUMA

- Unknown psimasy
.
stenosis

C. II

-
TRISMUS

-
cervical injury / ankylosis
. mandible #

Adults : GA

ANAETHESIA
children : LA

POSITION ( flexion at cervical spine and extension at atlanta -

occipital Joint
BOYCE JACKSON =) Neck flexion

( BARKING DOG ,
SNIFFING THE

MORNING AIR ,
SWORD

SWALLOW )

i BURP

. Gauze -
teeth

• Non -
dominant : DL scope

DIRECT INDIRECT

-
Inaccurate depth perception

be in contact
-
Tove and false VC appease to

•
Invested mirror image
GUEDER'S ARWAY
cosopharyngeal airways
 TRACHEOSTOMY
①
JACKSON METALLIC TOBE

② PORTEX
Functions of tracheostomy
cuffed tube

①
ALTERNATIVE
PATHWAY FOR BREATHING

③ IMPROVES ALVEOLAR VENTICATION

· ↓ DEAD SPACE

↓
RESISTANCE
TO AIRFLOW

③ PROJECTS AIRWAYS AGAINST ASPIRATION

④ PERMITS REMOVAL OF
TRACHEOBRONCHIAL SECRETIONS

⑤ TO ADMINISTER ANAETHESIA

⑥ INTERMITTENT A RESPIRATION
PRESSURE (When required beyond 72nos)

Indications
①
RESPIRATORYOBSTRUCTION

ii) INFECTIONS:CROUP, IPIGLOTTITIS,

ACUTE DIRTHERIA, LUDWIC'S ANGINA, PERIONSILLAR,

PARAPHARANGIAL OR RETROPHARYNGEAL ABSCESS

(ii) TRAUMA

iii) NEOPLASMS

(IV) fOREIGN BODYLARYNX

CV) EDEMA LARYAX

(v) B/C ABDUCTOR PARALYSIS

(VID CONGENITAL ANOMALIS

② RETAINED SECRETIONS

ii) INABILITYTO COUGH:COMA. SPINAL INJURIES, POLO, GBS, SPASM RESPIRATORY

OF

MUSCLES, TETANUS, FLIAMPSIA

ii) DAINFUL COUGH

(iii) ASPIRATION

③ RESPIRATORYINSUFICIENCY:IMPHYSEMA, CHRONIC BRONCHITIS, ATELECTASIS

 TYPES

① Emergency

② Elective [ Tranquil / Ood @ sly / Routine)

L
Therapeutic
[
prophylactic
Extensive sx
-

tongue
. f- 1008 Of mouth
•
mandibular resection

Laoyngofissuo @
-

③ Deomanent

① Percutaneous dilatation at
toacheostomy

.
patient is already intubate d

GUIDE WIRE
↓
DILATOR

↓
TRACHEOSTOMY TUBE
Procedure
·POSITION:SUDINE, NECK EXTENDED

INCISION; ①
VERTICAL INCISION
MIDLINE = FROM CRICOD->STERNAL NOTCH

(NECK)

② INCISION:SCM
TRANSVERSE LONG, TWO FINGER BREADTH THE
ABOVE STERNAL

NOTCH

#M
⑤
⑥
............ ②
①

·
THYROID ISTHMUS DISPLACED OR DIVIDED BJORK fLAP

[Link]
INJECTED INTO TRACHEA TO SUPPRESS COUGH

TRACHEOSTOMY

hi, HIGH =). ABOVE

T HE LEVEL OF THYROID ISTUMUS

VIOLATES IST TRACHEAL RING

MAYLEAD TO PERICHONDRITIS OF CRICOND CARTILAGE

OR SUBGLOTTIC STENOSIS

· INDICATION: PRE_OPERATIVELARYNGECTOMY CASES

(ii) MID =) MOST PREFERRED

THROUGH
DONE I OW # RING

(iii) COW:) BELOW THE

LEVEL OFISTHMUS

M
Cr 8
HIGH TRACHEOSTOMY

·
MID TRACHEOSTOMY

ISTHMUS DIVIDED commonsson

AND LIGATED

·IST TRACHEAL RING NEVER DIVIDED =>

MAYLEAD PERICHONDRITIS OF CRICOD CARTILAGE
TO

OR SUBGLOTTIC STINOSIS

OFAPPROPRIATE
TRACHOSTOMYTUBE SIZEINSERTED AND SECURED BYTAPES

·SKIN INCISION NOT TO SUTURED

BE ORPACKED TIGHTLYAS IT MAYLEAD TO SUBCUTANEOUS

EmPHYSENA
 ·TRACHEOSTOMYWITH SPEAKING
VALVE
= 3

Allow
ingress of air when

breathing in out
closes

when
breathing out

SUCTION AIDED TRACHEOSTOMY TUBE

TRACHEAL HOOK ·TROUSSEAU'S TRACHEAL DILATOR

SHARP
BLUNT

↓ Applied to lower loader of

coicoid
to retract
thysoid cartilage to stabilize
the trachea
isthmus upwards
or downwardS
 JACKSON TRACHEOSTOMY TUBE

·INNER TUBE OUTER TUBE

Silver:fuller,
① Jackson

cleoman silver)

-
② PUC:Thermolabile

③ Silicone:Bacteria and secretions do not

(v,2n, Ni) adhere, minimum

causting
⑦ Silliconized PVC

③ sialistic:acousting

⑥ Armoured toes:spiralings of
stainless
steel

i. pPV

(ii) can be used in patients

in which radiation is

required

(iii) prevents aspiration

·Deflation coff
of every 2nd for

Smin

1. Blue radiopaque line

2. Cuff
3. No inner tube Adults

(6YRS
·4:
893 ( z3 u)
=) 7.5 8
3.5
-
+
+

5t: 8.0- 8.5(8.5 -

q)

>6YRS
#g3
1
=
+
u.S
 Complications

IMMEDIATE

INTERMEDIATE LATE

-
HEMORRHAGE •
HEMORRHAGE DUE TO EROSION

-
APNEA .
BLEEDING OF MAJOR VESSEL

.
DISPLACEMENT OF TUBE . LARYNGEAL STENOSIS
RESPIRATORY
OBSTRUCTION OF TUBE
-
BLOCKING -
TRACHEAL STENOSIS

TRACHEOSTOMY -
SUBCUTANEOUS EMPHYSEMA -
TEF

•
TRACHEITIS , TRACHEO BRONCHITIS •
PERSISTENT TRACHEO CUTANEOUS
CO2 WASH OUT
.
ATELECTASIS ,
LUNG ABSCESS FISTULA

✗ DRIVE FOR CENTRAL . REACTIONARY OR 2° HEMORRHAGE '

KELOID OR SCAR
CHEMOSENSITIVE AREA
-
CORROSION OF TUBE . ASPIRATION

OF FRAGMENTS
APNEA

RX : -
CARBOGEN
(95%02 + 5%02)

• PNEUMOTHORAX : INJURY TO APICAL

PLEURA

•
INJURY TO RLN

-
ASPIRATION OF BLOOD

.
INJURY TO ESOPHAGUS

( TRACHEO ESOPHAGEAL FISTULA )

-
CARDIAC ARREST

Foreign body larynx

-
TOTAL OBSTRUCTION => SUDDEN DEATH

-
PARTIAL OBSTRUCTION -
DISCOMFORT OR PAIN IN THROAT

-
HOARSENESS

-
( ROU DY COUGH

.
APHONIA

-
DYSPNEA

•
WHEEZING

-
HEMOPTYSIS

Rx : -

i
HEIMLICH MANEUURE

CRICOTHYROTOMY OR EMERGENCY TRACHEOSTOMY

micoolaoyngo bronchoscopy
-
 NEEDLE
LUMBAR PUNCTURE

USES:-

① Infection

② SAH =) Xanthochromia

③ malignant cells

⑦ Aluminocytological dissociation

(GBS)

⑤ ↑
Ig Coligoclonal):MS

⑥ measure is pressure

⑦
Intrathecal drugs (m+X =
A(L)
⑧ myelography
⑨ PUO

DX

·
CSF:OligoclonalIggbands

TIWMRI =
pefiventricular plagues, coopus callosum (Dawson's fingers), Brainstern, cerebellum, sc
(m.c)

Iliacrest:12-13

Beveled edge facing the 500f

/22:

suRAnAcuNODsSforaoccenomo
 NORMAL PRESSURE HYDROCEPHALUS

Gait disturbance

Incontinence
cognitive
decline

SAH Head injury itomous

• Denovo 08 .
, meningitis

ventoiculomegaly
•

• CSF poessuoe :
④
•
Lumbar infusion testing : fine again at LP

}
±
Fluid Evaluation of benefit
Challenge
↓
CSF measurement

therapeutic

① spinal analgesia

② Intrathecal Mtx f-08 ALL

③ Normal pressure hydrocephalus

① Hydrocephalus
( communicating)

⑤ Pseudotumouo Ceo @ Osi

CSF collection

Tube 1 : culture , Goan stain

Tubez : Glucose , protein

Tube 3 : cell count and differential

+ Extoa CSF
LKOH
( INDIA INK
LADA

-
Reinsert stylet + Remove needle
 Ci -0

21300 OF
PLASMA

( > 100 )
( > 1000)

20-50

= UPTO 500

( SF
of
( Postponed if these is papist edema and / 08 Focal neurologic findings suggestive

4Poessuo@anint8acoanialmassj.T
-

Uobid C >
2501mm3)
⑨
-
cells : > 1000 / mm3 , DMNL
/ -
CHILDREN :< 8

-
NEWBORN :( 20

. Proteins :
7100mg / 91

< 40mg/ d /
.
sugao :

40dm stain Ghosaftes

} Become sterile 4-
•

-
CULTURE antibiotics

CSF [ TUBERCULAR)

CSF

'
↑ Poessuo @

- Cleao / ✗ anthocnoomic

. cobweb coagulum ( fibrinogen)

-
Lymphocytic pleocytosis

• lnpooteins [ SO -150mg / dl )

ICI [④ : 720
750mg/ 91 )
-
- -

.
mild & Glucose [ 20
-50mg/ dl )
-
AFB / culture

}
cells :
upto SOO / mm
-

- ADA
 cx : -

failed puncture
'

-
Traumatic puncture

- Infection

Brainstem herniation
-

POST DURAL
-
PUNCTURE HEADACHE

leakage of CSF
through duoal sent [ Prevention : blood lies down
Autologous patch Foo
.

2- 3h05 ;)
TRACTION ON CRANIAL
STRUCTURES ,

cerebral vasodilatation

CII : -
Traumatic tap SAH

-
↑ ICT - 1St : colored .
Sesia l samples : uniformly
Sesia : cleao coloured
. Skin infection near puncture site
.
⊖ . ✗ anthocnsomia
-

Bleeding disorder
-
f- sesh RBCs .
Lysed RBCs

Bone Massow Biopsy

① Slit@ tte =' GUARD 'S SPIRALLY

② Needle THREADED OVER
-
Lateral screw
NEEDLE
③ cap guaod

INDICATIONS : -

① Infections : malaria , Kala Aza 8

-
sample sent in liquid ② LSD : Gaucher 's ( sea blue histiocytes is)
F-DTA LATERAL SCREW
GUARD ③ unexplained : -
Anaemia ,

Thrombocytopenia ,

① pancytopenia

⑤ malignancy

⑥ PUO

⑦ LCH

⑧ can be used Foo

infusion
intoa osseous
 21 I

coagulopathy

·Hemodynamically unstable

·
osteogenesis imperfecta
 L wotcH

Biopsy
750cut needle
Looe
to
extends
he80+ 0m
+ +
↓ extend
Toe does not
to the bottom
FLOWMETER ANTERIOR
NASAL PRONGS
↑ NARES
crasal cannula

·
Maxfi02:44%.

·
FIOW:4 -8L

Lifmose is buying nasal

of mucosa
↓

cousting, bleeding
·
1L +
Fi02:24-

Every 11 in flow = fioz increases by 4%.

(21:28%.

32:32%.

YL: 38%.

6: 44/.

CAPACITY:- NO
fLOWMETER

·uses:93-95%. XTachyphea

MAX:152/min

Nasopharyngeal catheter

·
Maxfi02:40%

·
FIOW:
MAIN +
-

·length:Tipofnose Tagus
-

AUXILLARY
HOLES
·uses:93-95%. XTachyphea

XCAPACITY

Tip should lie just above would

 Nasal mask

fi02: 60%

Use:90-95%. slightly tachypheic (RR:20-25/min)

+
·

cNirmaSK:covers mouth)

Disadvantage:lowes f102 as compared to

N,V

simple face mask (Hudson's

EXPIRED
C ·
capacity:low
CO2
·minimum How: Slmin

L minimum flow requirement

to push outCO2, there is a

·
max 102:40-50%

Use:90-95%. slightly tachypheic (RR:20-25/min)

+
·

Nonsebreathing mask

↑ Janconision:
80.

flow:10-152/ min

valve

O2
from
2 places

Enriched Oz

Reservoir

1/205 (3 f017
 venturimask

·Bernoulliprinciple

GREEN:DiluteSO2 less fi02: 60%

BLUE:fi02: 24%

↓ B cdue + 0

S constrictions
->
Biggest - ROOM AIR
↓ 102 ENTERS

Oxygen Hood

warm, humidified Oz

> 7L/min

·
fi02:80-90%
(pICC)
PICC => sillicone

Rest:Polyurethane
③

①
SUN 24
S(2/ 22

fLOWER 20

LEAVES 18
501L 16

LAVA 14

GREEN:18G
PINK:20G

BLUE:229
YELLOW:24G
(DA,NE)