Intratracheal intubation

Therapeutic option for: Airway management

Also known as

• Intubation
• Endotracheal intubation

 

Not to be confused with:

• Tracheostomy

Tracheostomy

Therapeutic option for: Airway management

 

Not to be confused with:

• Intratracheal intubation

Noninvasive ventilation

Therapeutic option for: Artificial respiration

Also known as

• NIV

 

Not to be confused with:

• CPAP
• This is because CPAP does not ventilate, it merely provides continuous pressure.

Artificial respiration

Therapeutic option for: Airway management

Types

• High-frequency ventilation
• Interactive ventilatory support
• Liquid ventilation
• Noninvasive ventilation
• One-lung ventilation
• Positive-pressure respiration
• Ventilator weaning

Positive-Pressure Respiration

Therapeutic option for: Artificial respiration

Forms

• Continuous Positive Airway Pressure
• Intermittent Positive-Pressure Breathing
• Intermittent Positive-Pressure Ventilation

Continuous positive airway pressure

Type of: Positive-pressure respiration

Also known as

• CPAP

 

Not to be confused with:

• NIV
• This is because CPAP does not ventilate, it merely provides continuous pressure.

The ABCDE approach

A : airway
B : breathing
C : circulation
D : disability
E : exposure

Alternatively DEFG = Don't Ever Forget Glucose.

 

References

• Resuscitation council UK

Road traffic injuries

 

See also 

• World Health Organisation fact sheet

Electrical cardioversion

Types

Defibrillation

A shock is administered at a random point in the cardiac cycle. Emergency management of cardiac arrest which has occured due to a 'shockable rhythm'.

Synchronised electrical cardioversion

A shock is administered at a specific point in the cardiac cycle.

 

Indications

Synchronised electrical cardioversion

• Termination of certain cardiac arrhythmias

Defibrillation

• Ventricular fibrillation
• Pulseless ventricular tachycardia

 

Contraindications

• Asystole (ECG flatline) 
• Pulseless electrical activity

Diabetic hypoglycaemia

Diabetes mellitus 

This is a type of hypoglycaemia.
Also known as insulin shock (when severe).

 

History

• Rapid onset

Symptoms

• Headache
• Blurred vision
• Dizziness
• Tachycardia
• Confusion
• Tremors

 

Signs

• Diaphoresis (sweating)
• Pallor
• Low and falling GCS

 

Causes

• Treatment of diabetes mellitus
• Classically insulin overdose 
• Overdose of oral antihyperglycaemic agents

 

Complications

• Seizures
• Diabetic coma

Comparison with diabetic ketoacidosis

• DHG is more common than DKA
• Low blood glucose in DHG
• Faster onset of DHG
• Moist, pale in DHG
• Normal respirations in DHG
• Normal or high blood pressure in DHG
• Seizures common in DHG
• No dehydration in DHG
• Urine output normal in DHG
• Disoriented or comatose in DHG
• Rapid recovery after treatment of DHG

Management

• Glucose IV or PO
• Glucagon IV or IM

Multiple organ dysfunction syndrome

Also known as MODS, multiple organ failure, total organ failure, or multisystem organ failure.

Definition

Multiple organ dysfunction syndrome is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention. It usually involves two or more organ systems.

There are usually 6 organ systems described:

1. Circulatory derangement 
2. Pulmonary dysfunction
3. Gastrointestinal dysfunction
4. Liver dysfunction
5. Renal dysfunction
6. Central nervous system dysfunction

Prognosis

• 1 organ system failure (lasting over 24hr) : 40% mortality
• 2 organ system failure (lasting over 24hr) : 60% mortality
• 3+ organ system failure (lasting over 72hr) : 98% mortality

Glucose meter

Also known as the BM (Boehringer Mannheim) test.

This investigation uses a drop of blood to quickly determine the current glucose content of the blood.

Pulseless electrical activity

There is normal cardiac electrical activity but no pulse.

Defibrillation is not indicated.

Causes

• Cardiac tamponade 
• Constrictive pericarditis
• Aortic stenosis
• Tension pneumothorax

Airway management

Therapeutics

Categories

• airway, Extubation
• intubation, Intratracheal
• respiration, Artificial
• Tracheostomy

This refers to the evaluation of respiration and the range of techniques and devices which can restore and maintain sufficient pulmonary ventilation.

 

Airway

If a patient cannot maintain patency of their airways, these must be protected by medical therapy.

 

Noninvasive techniques

• Face mask 
• Supraglottic airway device (SAD)

 

CICO

If a patient cannot be mechanically ventilated with a face mask and cannot be intubated, the anaesthesiologist must quickly recognise the situation as: "cannot intubate, cannot oxygenate."   
This is a medical emergency and may necessitate a cricothyrotomy. 

 

Breathing

If the respiratory drive of a patient cannot maintain oxygenation, it becomes necessary to mechanically ventilate the patient by pumping air into their lungs.

 

Indications for mechanical ventilation

• General anaesthesia
• If a patient has a low GCS (<8/15) and shows signs of airway compromise
• Paralysis affecting the respiratory muscles