Intubation endotracheal

Bushnell CD, Phillips-Bute BG, Laskowitz DT, Lynch JR, Chilukuri V, Borel CO. Survival and outcome after endotracheal intubation for acute stroke. Neurology 1999 52(7) 1374-1381. 

Consider endotracheal intubation if respiratory assistance is needed... 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

Endotracheal intubation and IV access should be obtained when feasible, but not at the expense of stopping chest compressions. Once an airway is achieved, patients should be ventUated with 100% oxygen. 

Noninvasive positive-pressure ventilation (NPPV) provides ventilatory support with oxygen and pressurized airflow using a face or nasal mask with a tight seal but without endotracheal intubation. In patients with acute respiratory failure due to COPD exacerbations, NPPV was associated with lower mortality, lower intubation rates, shorter hospital stays, and greater improvements in serum pH in 1 hour compared with usual care. Use of NPPV reduces the complications that often arise with invasive mechanical ventilation. NPPV is not appropriate for patients with altered mental status, severe acidosis, respiratory arrest, or cardiovascular instability. 

Endotracheal Intubation Passage of a tube through the nose or the mouth into the trachea for maintenance of the airway during anesthesia or for maintenance of an imperiled airway. 

Cardiovascular Effects. In a recent report on the clinical treatment of phenol poisoning, Langford et al. (1998) provide a summary of a case report in which a woman accidentally consumed an ounce of 89% phenol which had been mistakenly been given to her in preparation for an in-office procedure. Her immediate reaction upon consuming the phenol was to clutch her throat and collapse, and within 30 minutes she was comatose and had gone into respiratory arrest. Treatment was initiated with an endotracheal intubation. Ventilation with a bag and mask led to the detection of a lamp oil odor. Within an hour she developed ventricular tachycardia which responded to cardioversion however, she subsequently developed (in the first 24 hours) supraventricular and ventricular dysrhythmias, metabolic acidosis, and experienced a grand mal seizure. After a 15-day hospital stay, she was completely recovered with no evidence of impaired motility or compromised gastrointestinal or cardiovascular systems. 

Shirkey 1971 Zieserl 1979) otherwise, endotracheal intubation followed by gastric lavage has been suggested (Ellenhorn and Barceloux 1988 Haddad and Winchester 1990). 

Exposure to and inhalation of concentrations of 2500-6500ppm, as might result from accidents with liquid anhydrous ammonia, cause severe corneal irritation, dyspnea, bron-chospasm, chest pain, and pulmonary edema that may be fatal. Upper airway obstruction due to laryngeal/pharyngeal edema and desquamation of mucous membranes may occur early in the course and require endotracheal intubation or tracheostomy. " Case reports have documented chronic airway hyperreactivity and asthma, with associated obstructive pulmonary function changes after massive ammonia exposures. ... 

Nitroglycerin IV Control of blood pressure in perioperative hypertension associated with surgical procedures, especially cardiovascular procedures, such as endotracheal intubation, anesthesia, skin incision, sternotomy, cardiac bypass, and in the immediate postsurgical period. 

As a primary anesthetic for induction of anesthesia in general surgery when endotracheal intubation and mechanical ventilation are required. 

Induction of anesthesia - Administer at an infusion rate of 0.5 to 1 mcg/kg/min with a hypnotic or volatile agent for the induction of anesthesia. If endotracheal intubation is to occur less than 8 minutes after the start of infusion of remifentanil, then an initial dose of 1 mcg/kg may be administered over 30 to 60 seconds. 

Maintenance of anesthesia - After endotracheal intubation, decrease the infusion rate of remifentanil in accordance with the dosing guidelines in the table above. Because of the rapid onset and short duration of action of remifentanil, the rate of administration during anesthesia can be titrated upward in 25% to 100% increments or downward in 25% to 50% decrements every 2 to 5 minutes to attain the desired level of p-opioid effect. In response to light anesthesia or transient episodes of intense surgical stress, supplemental bolus doses of 1 mcg/kg may be administered every 2 to 5 minutes. At infusion rates more than 1 mcg/kg/min, consider increases in the concomitant anesthetic agents to increase the depth of anesthesia. 

Epidural/Intrathecal administration Limit epidural or intrathecal administration of preservative-free morphine and sufentanil to the lumbar area. Intrathecal use has been associated with a higher incidence of respiratory depression than epidural use. Asthma and other respiratory conditions The use of bisulfites is contraindicated in asthmatic patients. Bisulfites and morphine may potentiate each other, preventing use by causing severe adverse reactions. Use with extreme caution in patients having an acute asthmatic attack, bronchial asthma, chronic obstructive pulmonary disease or cor pulmonale, a substantially decreased respiratory reserve, and preexisting respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Reserve use for those whose conditions require endotracheal intubation and respiratory support or control of ventilation. In these patients, consider alternative nonopioid analgesics, and employ only under careful medical supervision at the lowest effective dose. 

Airway. Ensure a patent airway via endotracheal intubation or cricothyrotomy (ie, inferior laryngotomy, used prior to tracheotomy) and administer oxygen. Severe respiratory difficulty may respond to IV aminophylline or to other bronchodilators. Hypotension The patient should be recumbent with feet elevated. Depending upon the severity, consider the following measures ... 

Contemporary anesthetic management requires (1) rapid loss of consciousness, which eliminates awareness, memory of pain, anxiety, and stress throughout the surgical period (2) a level of analgesia sufficient to abohsh the reflex reactions to pain, such as muscular movement and cardiovascular stimulation (3) minimal and reversible influence on vital physiological functions, such as those performed by the cardiovascular and respiratory systems (4) relaxation of skeletal muscle to facilitate endotracheal intubation, provide the surgeon ready access to the operative field, and reduce the dose of anesthetic required to produce immobihty (5) lack of... 

The principal advantage of succinylcholine is its rapid and ultra-short action. With intravenous (IV) administration, succinylcholine produces flaccid paralysis that occurs in less than 1 minute and lasts about 10 minutes. This makes it suitable for short-term procedures, such as endotracheal intubation, setting of fractures, and pre-... 

Maintenance of a patent airway. Use oropharyngeal or nasopharyngeal airway or endotracheal intubation if airway obstruction persists. 

If exposure is via inhalation, the exposed individual should be moved to fresh air and efforts should be directed toward the maintenance of an open airway, airway suctioning, endotracheal intubation. Artificial ventilation with supplemental oxygen may be helpful. 

An asthmatic patient using inhaled budesonide and salbutamol developed an acute asthma attack. Despite emergency treatment the patient deteriorated, requiring endotracheal intubation and assisted ventilation, and there was no improvement until the glucocorticoid was withdrawn, after which there was steady improvement. Skin prick tests with prednisolone, sodium hemisuccinate, and 6-methylprednisolone-sodium hemisuccinate were positive. Thirty minutes after intradermal 6-methylprednisolone-sodium hemisuccinate 4 mg, the patient developed a dry cough, dyspnea, and wheezing and a 17% fall in FEVi. 

Jackson WL Jr. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock A critical appraisal. Chest 2005 127 1031-8. 

The first treatment for methanol poisoning, as in all critical poisoning situations, is support of respiration. For hospitalized patients, gastric lavage should be carried out after the airway has been protected by endotracheal intubation. Activated charcoal is not useful. 

Therapeutic uses Because of its rapid onset and short duration of action, succinylcholine is useful when rapid endotracheal intubation is required during the induction of anesthesia (a rapid action is essential if aspiration of gastric contents is to be avoided during intubation). It is also employed during electroconvulsive shock treatment. 

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