Emergency Airway Management 2nd editon by Andrew Burtenshaw – Ebook PDF Instant Download/Delivery: 1107661250, 9781107661257
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ISBN 10: 1107661250
ISBN 13: 9781107661257
Author: Andrew Burtenshaw
From principles of oxygen delivery and patient assessment, through rapid sequence induction of anaesthesia and tracheal intubation, to the difficult and failed emergency airway, this book from an expert team of clinicians guides the reader through every aspect of emergency airway management. Retaining the concise, accessible format of the first edition, it includes a new section on human factors and improving teamwork and performance, an expanded special circumstances section, and a summary of the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society and its implications for practice. Updated guidelines, new technologies such as videolaryngoscopy, and recent evidence have all been incorporated into the chapter content, ensuring that the book reflects best current practice. This thoroughly updated new edition remains an essential resource for navigating a highly challenging clinical scenario and will be of value to emergency medicine, intensive care, anaesthesia and acute medicine clinicians.
Emergency Airway Management 2nd Table of contents:
Chapter 1 Introduction
Introduction
Audit and skills maintenance
Summary
Chapter 2 Delivery of oxygen
Objectives
Causes of hypoxaemia
Alveolar hypoventilation
Mismatch between ventilation and perfusion within the lungs
Pulmonary diffusion defects
A reduced inspired oxygen concentration
How much oxygen?
Devices used for delivery of oxygen
Spontaneous ventilation
Variable-performance devices: masks or nasal cannulae
Fixed-performance devices
Assisted ventilation
The bag-mask device
The anaesthetic breathing system
Using the Mapleson C breathing system
Pitfalls when using an anaesthetic breathing system
Spontaneous ventilation
Assisted ventilation
Monitoring oxygenation
The pulse oximeter
Arterial blood gas analysis
Pre-oxygenation
Summary
Chapter 3 Basic airway management
Objectives
Introduction
Positioning
Airway manoeuvres
Chin lift
Jaw thrust
Suction
Airway adjuncts
Oropharyngeal airways
Nasopharyngeal airways
Oxygenation
Spontaneous ventilation
Assisted ventilation
Summary
Chapter 4 Indications for intubation
Objectives
Introduction
General considerations
Clinical indications for intubation
Apnoeic patient
Patient with obstructed or partially obstructed airway who does not respond to basic airway manoeuvres
Facial trauma
Laryngeal disruption/swelling
Coma with difficult airway or profuse vomiting
Reversible causes: fitting, coma and anaphylaxis
Patient requiring invasive respiratory support for ventilatory failure or critical oxygenation
Type 1 respiratory failure
Type 2 respiratory failure
Reversible causes: bronchospasm, pneumothorax, acute pulmonary oedema and opioids
Patients in whom basic airway care is effective, but the predicted clinical course includes high probability of airway obstruction, aspiration or ventilatory failure
Impaired consciousness with agitation
Severe shock with acidaemia
Reversible causes: hypoglycaemia and fitting
Summary
Acknowledgement
Chapter 5 Airway assessment
Objectives
Introduction
Definition of a difficult airway
General assessment of patients before inducing anaesthesia
Airway assessment
Predicting difficulty in bag-mask ventilation (BMV)
Features likely to cause difficulty in achieving a good seal with a facemask
Features likely to cause difficulty in maintaining an airway without intubation
Features likely to make it difficult to ventilate the lungs
Predicting difficult intubation
Previous history of a difficult airway
Body morphology
Facial features
Neck
Mallampati and other scoring systems
Predicting a difficult cricothyroidotomy
Features that may cause difficulty in accessing the cricothyroid membrane
HAVNO
What to do if a difficult airway is predicted
Summary
Chapter 6 Preparation for rapid sequence induction
Objectives
Introduction
Positioning
Positioning for pre-oxygenation
Positioning for intubation
Equipment
Basic resuscitation equipment:
Advanced airway equipment:
Failed intubation equipment:
Trolley
Suction
Oxygen delivery apparatus
Backup oxygen supply
Airway adjuncts
Laryngoscopes
Direct laryngoscopy
Indirect laryngoscopy
Tracheal tubes
Bougies and stylets
Ventilation system
Equipment for failed intubation
Drugs
Attach
Oxygen
Monitoring
Oxygen analyzer
Electrocardiograph
Non-invasive blood pressure
Pulse oximetry
Capnography
Checks
Checklists and team briefings
Resuscitation
Brief history
Intravenous access
Neurology
Help
Call for help
Organize team members
Review and feedback
Summary
Acknowledgement
Chapter 7 Pharmacology of emergency airway drugs
Objectives
Introduction
Hypnosis
Induction drugs
Etomidate
Indications
Induction characteristics
Physiological effects
Dose
Propofol
Indications
Induction characteristics
Physiological effects
Dose
Thiopental sodium
Indications
Induction characteristics
Physiological effects
Dose
Ketamine
Indications
Induction characteristics
Physiological effects
Dose
Midazolam
Indications
Induction characteristics
Physiological effects
Dose
The elderly
Analgesia
Opioids
Neuromuscular blocking drugs
Suxamethonium
Use
Effects
Contra-indications
Side effects
Dose
Hyperkalaemia
Bradycardia
Muscle fasciculation
Muscle pain
Histamine release
Prolonged neuromuscular block
Non-depolarizing muscle relaxants
Sugammadex
Potential drug-related complications
Malignant hyperthermia
Anaphylaxis
Summary
Acknowledgement
Chapter 8 Rapid sequence induction and tracheal intubation
Objectives
Introduction
Preparation
Pre-oxygenation
Apnoeic oxygenation
The technique of rapid sequence induction
Cricoid pressure
Laryngoscopy and intubation
Videolaryngoscopy
Confirmation of tracheal tube placement
Post-intubation review
Summary
Acknowledgement
Chapter 9 Difficult and failed airway
Objectives
Failed first attempt at tracheal intubation during RSI
Ensuring oxygenation
Oxygenation techniques
Use of a supraglottic airway device (SAD)
Technique of insertion of an i-gel SAD
Intubating conditions
Can the laryngeal view be improved?
Head elevation
External manipulation of larynx
Use of an alternative laryngoscope or blade
Use of an alternative laryngoscope
Videolaryngoscopy
Change of practitioner
If the second laryngoscopy fails to improve the view
If repeat laryngoscopy fails, but oxygenation is maintained
If repeat laryngoscopy fails, and oxygenation is not maintained
Is a surgical airway necessary?
Are the patient’s lungs being ventilated maximally with oxygen?
Is a surgical airway necessary?
Is arterial oxygenation stable and survivable? Can it be improved?
Is a surgical airway necessary?
Will a surgical airway be possible?
Techniques for rescue ventilation
Needle cricothyroidotomy
Equipment required
Technique
Surgical cricothyroidotomy
Equipment required
Technique
Tracheostomy
Summary
Acknowledgement
Chapter 10 Post-intubation management
Objectives
Introduction
Airway
Is the airway secure?
Has end tidal CO monitoring been attached?
Is the cervical spine adequately stabilized?
Is an HME filter (heat and moisture exchange) at the patient end of the circuit?
Breathing
Is ventilation satisfactory?
Transport ventilators (, and )
Initial ventilator set up using the Oxylog 3000 as an example
Ventilator trouble shooting
Are tube positions correct?
Has a nasogastric or orogastric tube been placed?
Are chest drains required?
Circulation
Hypotension
Hypertension
Disability
Sedation and analgesia
Neuromuscular blocking drugs
Seizure control
Exposure and environment
Transfer to definitive management
Preparation
Personnel
Equipment
Documentation
Communication
Considerations during transport
Extubation
Summary
Acknowledgement
Chapter 11 Emergency airway management in special circumstances
11.1 Paediatrics
Objectives
Introduction
Special considerations in children
Equipment
Oropharyngeal airways
Facemasks
Suction
Yankauer
Narrow-bore
Breathing systems
Self-inflating bags
Ayres T-piece
Laryngoscopes
Tracheal tubes
Stylets and bougies
RSI technique in children
Pre-oxygenation
Laryngoscopy
Fixation of the tracheal tube
Ventilators
The difficult airway in children
Summary
11.2 Major trauma and raised intracranial pressure
Objectives
Introduction
Airway
Cervical spine management
Rapid sequence induction in trauma and traumatic brain injury
Breathing
Circulation
Neurological injury
Post-intubation management
Transport and monitoring
The agitated patient
Summary
Acknowledgement
11.3 Cardiorespiratory failure
Objective
Introduction
Respiratory emergencies
Asthma
Chronic obstructive pulmonary disease (COPD)
Cardiovascular emergencies
Acute cardiogenic pulmonary oedema
Cardiogenic shock
Dissection of the thoracic aorta or rupture of an abdominal aortic aneurysm
Cardioversion
Sepsis
Anaphylaxis and angio-oedema
Summary
Acknowledgement
11.4 Non-traumatic coma and seizures
Objectives
Introduction
Risks to the comatose or convulsing patient
Immediate treatment principles
Indications for intubation in the non-traumatic coma or convulsing patient
The technique of tracheal intubation
The comatose patient
Pre-oxygenation
Cricoid pressure
Drugs for induction of anaesthesia
Neuromuscular blocking drugs
Adjuvant treatment
The convulsing patient
Pre-oxygenation
Drugs for the induction of anaesthesia
Adjuvant treatment
Pitfalls
Summary
Acknowledgement
11.5 Pre-hospital care
Objectives
Background
Pre-hospital rapid sequence induction in an emergency medical service
Indications
Principles
Technique
Safety
Patient access
Patient positioning
Environment
Equipment
Assistance
Summary
Acknowledgement
11.6 The pregnant patient
Objectives
Introduction
Special considerations in the obstetric patient
Physiological
Anatomical
Pharmacology specific to the obstetric patient
Rapid sequence induction and tracheal intubation
Failed intubation and failed ventilation
Whether to wake or continue?
Pre-eclampsia
Training
Summary
Chapter 12 Non-invasive ventilatory support
Objectives
Introduction
Modes of non-invasive ventilation
Mechanisms of action
Continuous positive airway pressure
Non-invasive positive pressure ventilation
Clinical uses
Chronic obstructive pulmonary disease
Cardiogenic pulmonary oedema
Patient suitability
Contra-indications
Complications
Environment
Equipment
Interface
Procedure
General approach to initiating NIV (CPAP or NIPPV)
Monitoring during treatment
Failure of non-invasive ventilatory support
Summary
Chapter 13 Human factors, audit and skills maintenance
Objectives
Introduction
Human factors and non-technical skills
Human factors at the individual level
The individual
Physical and mental health
Multi-tasking and the role of habit
Situational awareness, fixation error, confirmation bias and normalized deviance
Human factors at the team level
Communication
Situation:
Background:
Assessment:
Recommendations:
Closed loop communication
Human factors at the organizational level
Organizational culture
Standardization of tasks and checklists
Critical incident reporting and reflective learning from error
Technology and device design
Latent risk factors
Training and simulation
Audit and skills maintenance
Principles of clinical audit
Personal audit
Departmental audit
Skills maintenance
Interdepartmental interfaces
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