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AIRWAY III

DIRECT LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

Dr. Richard Levitan, M.D.


I. Historical perspective


A. early intubation equipment

B. modern blade design

C. unique/special purpose blades


II. Indications for direct laryngoscopy and intubation


A. cardio/respiratory arrest

B. hypoventilation

C. hypoxia

D. aspiration prevention

E. general anesthesia


III. Prediction of difficult direct laryngoscopy


IV. Prelaryngoscopy preparation of equipment


A. equipment

B. laryngoscope blade design and selection

C. back-up devices


V. Patient positioning


A. alignment of axes

B. provisions for the unstable neck


VI. The laryngoscopist's view


A. glottic views/grades

B. monocularity of laryngoscopy

C. effect of laryngoscopist's body position


VII. Direct laryngoscopy technique


A. blade insertion techniques

B. andmark identification

C. endotracheal tube passage

D. use of stylets


VIII. Specific problems and solutions


A. difficult blade insertion in the obese patient

B. absence of any landmarks

C. ineffective lighting

D. grade III and IV views

E. inability to pass endotracheal tube

F. effects of cricoid pressure/tracheal manipulation

G. use of lip retraction

H. head lift

I. blade repositioning


IX. Complications of direct laryngoscopy and intubation


A. hypoxia

B. esophageal intubation

C. glottic and epiglottic edema

D. vocal cord injury

E. tracheal perforation

F. dental trauma

G. endobronchial intubation

H. pulmonary aspiration

I. laryngospasm

J. bronchospasm

K. cervical spine injury

L. increased intracranial pressure

M. increased intraoculary pressure



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