1.
LARYNGOSCOPE
TYPES
Macintosh’s curved blades laryngoscope
Magill’s straight blades laryngoscope.
USES
1. Direct laryngoscopy
2. Removal of foreign body
3. Endotracheal Intubation
Contra indications
1. Cervical Spine Injury
2. Marked Hypoxia (Bag mask ventilation should be carried out first)
3. Severe deforming trauma to the facial structures
Complications
1. Trauma to the teeth lips and tongue
2. Trauma to the upper airway
3. Laryngeal edema
4. Hemodynamic instability
2. Metered dose Inhaler
A hand held aerosol propellant used to deliver medications such as short acting
beta agonists/long acting beta agonists/ inhaled steroids
Advantages:
Portable
Combination drugs can be delivered
Lesser risk of bacterial contamination
Disadvantages:
Oropharyngeal deposition
Need for correct actuation and inhalation coordination
[Link]
A drug delivery device that is used to deliver medications to
the upper and lower airway in the form of mist
Uses:
1. Asthma
2. COPD
3. Bronchospasm
4. Atelectasis
5. To aid expectoration of thick respiratory secretions
[Link] airway (Oropharyngeal airway)
Oropharyngeal airway is used to protect the airway by
preventing the tongue from falling back and occluding the
airway
Indication:
1. Unconscious/ sedated patient
Contraindications
1. Conscious patient ( Intact gag reflex)
2. Oropharyngeal growth
Uses:
1. Airway protection
2. To prevent tongue bite
3. To facilitate suction of oropharynx
4. As a conduit to pass devices into the oropharynx
5. To obtain a better mask fit
[Link] Mask Airway
It’s a supraglottic airaway device that keeps the airway open to
provide unobstructed ventilation. In emergency situations
where endotracheal intubation may be difficult laryngeal mask
airway can be used
Uses
1. As a means of rescue ventilation where endotracheal
intubation has failed and bag mask ventilation is insufficient
2. Difficult endotracheal intubation
3. Conduit for endotracheal tube
4. Elective intubation for Short procedures where
endotracheal intubation is not necessary
Contra indications:
1. Post prandial states( due to increased risk of aspiration of
gastric contents)
Complications
1. Upper airway trauma
2. Laryngospasm
3. Aspiration of gastric contents
4. Local irritation
5. Mild sympathetic stimulation
6. Bag Valve Mask (Ambu Bag)
A self inflating resuscitating device used for bag mask ventilation
USES
• administration of high flow O2
• provision of PEEP (positive end-expiratory pressure)
• provision of controlled ventilation
• provision of augmentation of spontaneous ventilation
COMPLICATIONS
• easy to hyperventilate patients and limited ability to gauge tidal volumes
• unable to gauge lung compliance (cf. a ventilator or Water’s circuit)
• poor seal is common if one-handed CE grip is used
• gastric distension
• aspiration
• claustrophobia
• exhaled secretions and moisture can result in exhalation valve dysfunction
and increased resistance to expiration
• risk of barotrauma if pop off valve close as unable to feel lung compliance
with self-inflating bags
• if high free gas flows are not used high FiO2 will not be achieved
• equipment failure (e.g. due to incorrect assembly
[Link] MASK
It is used to supply controlled proportion of inspired O 2 especially in cases of CO2 retention and
hypoxia. As high flow O2 can lead to respiratory depression in these cases. These are hence used
in cases of type II respiratory failure e.g. COPD, neuromuscular diseases, kyphoscoliosis etc. The
masks are colour coded and the colour indicates the % of O2 that it will supply.
“BE WITH OUT YOUR RIGHT GUN”
Blue 24% (O2 supply to be adjusted at 2L/min) White 28% (O2 supply to be adjusted at 4L/min)
Orange 31% (O2 supply to be adjusted at 6L/min) Yellow 35% (O2 supply to be adjusted at 8L/min)
Red 40% (O2 supply to be adjusted at 10L/min) Green 60% (O2 supply to be adjusted at 12L/min)
SIDE EFFECTS OF O2 THERAPY
1. O2 induced hypoventilation (in type II resp failure) 2. Atelectasis
3. Pressure necrosis of skin at fitting site 4. Depression of cilliary function
5. Oral dryness 6. Uncomfortable
8. IV CANULA
INDICATIONS
1. To give IV fluids 2. To give IV antibiotics
3. To give blood and blood products 4. To give immunoglobulins
COMPLICATIONS
[Link] 2. Embolization
3. Philibitis 4. Local skin infection
5. Sepsis
COLOUR GUAGE FLOW RATE (ml/min)
Orange 14 G 240
Grey 16 G 180
White 17 G 125
Green 18 G 90
Pink 20 G 60
Blue 22 G 36
Yellow 24 G 20
Violet 26 G 13
9. ETT
TYPES
Cuffed and non cuffed
INDICATIONS
1. Respiratory arrest/failure 2. Cardiac arrest
3. Administration of mechanical ventilation 4. GCS<8 (Inability to protect airway)
5. Patients with impending airway obstruction (burn, anaphylaxis)
6. Administration of general anaesthesia
SIZES
The size of ETT indicates internal diameter of the tube
Adult males: 8.0-9.0mm
Adult female: 7.5-8.0mm
TUBE POSITIONING
Tube is to be fixed so that the mark 20 for females and 22 for males is at the level of lips
EQUIPMENT REQUIRED FOR ETT PLACEMENT
1. Suction machine 2. O2 supply
3. ambu bag with its mask 4. stylet
5. Well functioning laryngoscope with both curved and straight blades
6. ETT of preferable size and a size below less than it 7. Tie
8. Airway 9. Syringe to inflate balloon
10. Pulse oxymeter or capnograph
11. Drugs [relaxant (succinyl choline 1-1.5mg/kg. caution in ARF or CRF. Contraindicated in
hyperkalemia) and sedative (midazolam 0.1-0.2mg/kg or lorazepam. May cause hypotension)
and/or analgesics (morphine or fentanyl. Augment the respiratory depressive effect of
benzodiazapines)].