Browsing Tag

airway

Passy Muir Valve

Normally air moves in and out of tracheostomy tubes (trachs) below the level of the vocal cords rendering a patient aphonic. By using a Passy Muir Valve (PMV), otherwise known as a "speaking valve", airflow is redirected through the vocal…

Bronchopulmonary Segments

Anatomically, the trachea extends from the cricoid cartilage (level of C6/C7) to the carina (T4/T5) and is reinforced anteriorly by approximately 20 semicircular, cartilaginous rings. The trachea divides into the right and left mainstem…

Repairing Endotracheal Tube Cuffs

Occlusive cuffs on endotracheal tubes (ETTs) allow us to "protect the airway." Air/fluid is added and removed from this cuff through a pilot balloon (blue in the image below) which is connected to the cuff on the distal segment of an ETT…

Extubation Criteria and Failure

Extubation most commonly refers to removal of an endotracheal tube (ETT) to transition a patient back to spontaneous respiration; however, when is it appropriate to do so? How do we know the patient is ready and won't require reintubation?

Expanding Neck Hematoma Management

Neck hematomas are a life threatening albeit rare post operative complication of surgeries in the cervical spine and neck (thyroidectomy, carotid endarterectomy, etc.) The overwhelming majority of patients who undergo these types of…

Awake Fiberoptic Intubation

This month has been riddled with challenging airway situations, so I thought it would be a great opportunity to discuss how I perform awake fiberoptic intubations. The decision to intubate someone awake is rooted in the high likelihood that…

Reinforced Endotracheal Tubes

When I first started my anesthesiology training, I almost always used a reinforced endotracheal tube (ETT) for cases where my patient would be positioned prone for an extended period of time. One can imagine that in this position, even if…

DNI Without DNR?

"Do not intubate" (DNI) and "do not resuscitate" (DNR) are two different entities. Often times a tenuous cardiopulmonary status or altered mentation requires securing the airway with endotracheal intubation well before full-on resuscitation…

Exchanging Endotracheal Tubes With A Cook Catheter

When exchanging an endotracheal tube (ETT) for a new single lumen tube (SLT) or double lumen tube (DLT), a paramount concern is losing the patient's airway. Most institutions use some form of an exchange catheter to facilitate ETT …

Difference Between MAC and Sedation

Medical procedures span such a vast spectrum. A simple peripheral IV placement often requires no anesthetic whereas complex cardiovascular surgeries warrant carefully administered general anesthetics. Procedures like external reductions of…