Endotracheal Intubation

 

Endotracheal intubation is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.

INDICATIONS
Specially, Endotracheal intubation is used for the following conditions ::
1. Respiratory arrest
2. Respiratory failure
3. airway obstruction
4. need for prolonged ventilatory support
5. Class III or IV hemorrhage with poor perfusion
6. severe flail chest or pulmonary contusion
7. multiple trauma, head injury and abnormal mental status

8. inhalation injury with erythema/edema of the vocal cords

9. protection from aspiration

CONTRAINDICATIONS
1. Unskilled operator.
2. Awake patient, jaw clenching.

TECHNIQUE
1. Pre-oxygenate with 100% non-rebreather or bag-valve mask and position patient in the ‘sniffing position’ with neck flexed and head extended on a pillow.
2. Remove poorly fitting dentures and suction oropharynx.
3. Standing at the patient’s head, hold the laryngoscope in the left hand and gently insert the laryngoscope blade over the right side of the tongue.
4. Advance the curved blade of the laryngoscope until the tip of the blade sits within the vallecula. Lift the blade forwards and upwards (taking care not to use the upper teeth as a fulcrum) to visualize the vocal cords.
5. Use the BURP (backward, upward, rightward pressure) manoeuvre on the thyroid cartilage as necessary to improve the view of the vocal cords.
6. Pass the endotracheal tube (size 8.5–9.5 mm internal diameter in adult males, and a 7.5–8.5 mm diameter in adult females) through the cords under direct vision, to a distance of 20–22 cm at the lips.
(i) Insert an introducer first to ‘stiffen’ the tube to facilitate placement.
7. Inflate the cuff, connect the oxygen supply, and check correct position of the tube by exhaled carbon dioxide detection, and by observing tube fogging, bilateral chest expansion and auscultation. Tie the tube in place.
8. Ventilate the lungs at 10 breaths/min.

COMPLICATIONS
1. Failure to intubate, with hypoxia.
2. Misplaced tube, e.g. oesophagus, or right main bronchus.
3. Airway trauma.
4. Aspiration.
5. Raised intracranial pressure.

5 Common Causes of COPD

1. Smoking. Cigarette smoke is by the far the most common reason people get COPD. You can also get it from tobacco products, like cigar and pipe smoke, especially if you breathe in the smoke.
2. Secondhand smoke. Even if you don't smoke yourself, you can get COPD from living with a smoker and breathing in the smoke.
3. Pollution and fumes. You can get COPD from air pollution. Breathing in chemical fumes, dust, or toxic substances at work can also cause it.
4. Your genes. About 2 to 3 in 100 people with COPD have a defect in their DNA, the code that tells your body how to work properly. This defect is called alpha-1 antitrypsin deficiency or AAT deficiency. Your lungs don't have enough of a protein needed to protect them from damage. This can lead to severe COPD. If you or a family member had serious lung problems -- especially at a young age -- ask your doctor about testing for AAT deficiency. 
5. Asthma. It's not common, but asthma can lead to COPD. If you don't treat your asthma, over time you can get lifetime damage.

PATIENT HISTORY[ बिरामी को ईतिहास]

रोग  पत्ता लगाउनका लागि HISTORY TAKING  महतपूर्ण भूमिका रहेको हुन्छ । ७०-८० प्रतिसत रोग त बिरामीको ईतिहास बाट नै थाहा हुन्छ । त्यसैले बिरामी को राम्रो सँग ईतिहास लिन जरुरी छ

                                    कसरी लिने त बिरामी को ईतिहास
                                   COMPONENT OF PATIENT HISTORY
.Chief complaint
.History of the present illness
.Past medical and surgical history
.Family history
.Social history
.Allergies and medications
.Review of systems


                   यिनी कुराहरु को बिस्तृत रुपमा  जानकारी लिन जरुरी हुन्छ । 

                                                                                                                  ref/nawalparasi health worker


 

Shock

Shock is a life-threatening medical emergency condition characterized by profoundly low blood pressure and tissue hypoperfusion. Shock can cause multiple organ failure. It may progress to death unless there is immediate medical intervention.

Types of Shock
1. Hypovolemic Shock
2. Anaphlactic Shock
3. Cardiogenic Shock
4. Neurogenic Shock
5. Septic Shock
6. Diabetic Shock

Common Causes of Shock
1. Ignificant blood loss
2. Fluid loss
3. Dehydration
4. Allergic Reaction
5. Reduced blood pressure
6. Heart failure
7. Nerve damage
8. Blood infections
9. Spinal cord injury

Reference : 
1. Health & Medical Information (HMI) :
http://www.healthmedicalinfohmi.blogspot.com/2015/10/shock.html