Intubated

Treatment for acute exposure to benzene vapor involves removing the subject from the affected area, followed by artificial respiration with oxygen intubation and cardiac monitors may be necessary for severe acute exposures (125,127). Because of its low surface tension, benzene poses a significant aspiration hazard if the liquid enters the lungs. Emesis is indicated in alert patients if more than 1 mL of benzene per kg of body weight has been ingested and less than two hours have passed between ingestion and treatment (127). 

Sufentanil, fentanyl, remifentanil, alfentanil, and morphine sulfate should be administered only by those specifically trained in the use of IV and epidural anesthetics Oxygen, resusdtative, and intubation equipment should be readily available. 

Propofol (Diprivan) is used for induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures and procedures that use a local anestiietic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in intensive care units. 

Dosage. TCDD was dissolved in acetone subsequently, one part of the acetone solution was added to and mixed with nine parts of USP corn oil. The acetone-corn oil solution of TCDD was given to rats at a rate of 5 ml/kg by intubation. This volume of solution provided a dose of 50 fxg/kg and 0.14 )LtCi/kg TCDD- C. 

When cyanosis occurs, oxygen should be supplemented by a facemask or by an oropharyngeal airway with a flow rate of about 7 liters/min. When indicated or when there is a ventilatory insufficiency, intubation should be performed to support breathing. Patients who are vomiting should be positioned adequately in order to avoid aspiration (table 1). 

Airway equipment (pharyngeal airway, laryngeal mask, supplies for intubation)... 

Epinephrine is widely used in clinical medicine for its multiple pharmacologic effects particularly for its potent vasoconstrictor effects. For example, in a dilute solution of 1 100,000, it provides a surgical tourniquet and facilitates a blood-free operating field. It is administered by nebulizer and face mask for post-intubation croup and for viral croup. 

Depending upon the location and severity of the stroke at admission, patients may have cardiac and/or respiratory instability at the time of presentation to the emergency department (ED). They may need to be stabilized hemodynamically or intubated for airway protection or respiratory distress. Blood pressure management is often a crucial management issue, and the use of vasopressor or antihypertensive medications is common. In stroke patients at risk for malignant cerebral... 

Stroke patients who require mechanical ventilation are not necessarily destined for a poor outcome. In a study by Santoli et al., 58 patients underwent mechanical ventilation and 16 survived. Eleven achieved a Barthel Index (BI) score of 60, indicating a good outcome. Within this study population, those patients with bilaterally absent comeal and pupillary reflexes had uniformly poor outcomes, underscoring the need for careful assessment of brainstem reflexes in intubated stroke patients. Other factors that have been associated with poor outcome in intubated stroke patients are advanced age and lower Glasgow Coma Score (GCS) at the time of intubation, as well as seizures and pulmonary edema. ... 

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. 

Oxygen/positive end expiratory pressure (PEEP)/intubation as needed... 

Dysarthria 0 = normal articulation 1 = mild-to-moderate 2 = severe 9 = intubated... 

For patients still intubated, can the patient answer the following four questions correctly ... 

Early-onset (within 48-72 h after mechanical intubation)... 

Consider endotracheal intubation if respiratory assistance is needed... 

Many experts would mechanically intubate the patient if a loading dose of phenobarbital is required... 

Pulmonary Normal breath sounds, undergoing tracheal intubation for mechanical ventilation CV ECG shows sinus tachycardia, otherwise normal Abd Within normal limits... 

Does the patient have an adequate airway and ventilation (hemoglobin saturation greater than 92%) If not, trained emergency personnel should consider performing tracheal intubation with initiation of mechanical ventilation. 

It is critical to differentiate acute and chronic respiratory acidosis, as the acute form is often a medical emergency that requires intubation and mechanical ventilation, whereas the chronic form is typically a stable condition. The blood gases in Case Study 2 came from a patient with advanced emphysema who is a "C02 retainer" due to ineffective ventilation. Because this patient s disease is chronic, the elevated PaC02 developed very slowly and allowed for metabolic compensation. 

Diprivan) 40 mg every 1 0 seconds titrated to EEG) depression intubation high lipid load (increased calories) propofol infusion syndrome... 

Pentobarbital (Nembutal) 1 0-1 5 mg/kg Up to 50 mg/minute 10-20 mcg/mL (typically titrated to EEG) Hypotension, respiratory depression, cardiac depression, infection, ileus Requires mechanical intubation, pressors, hemodynamic monitoring... 

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