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Research ArticleConference Proceedings

Elective IntubationDiscussion

Charles G Durbin, Christopher T Bell and Ashley M Shilling
Respiratory Care June 2014, 59 (6) 825-849; DOI: https://doi.org/10.4187/respcare.02802
Charles G Durbin Jr
Department of Anesthesiology, University of Virginia Health Science System, Charlottesville, Virginia.
MD FAARC
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  • For correspondence: [email protected]
Christopher T Bell
Department of Anesthesiology, University of Virginia Health Science System, Charlottesville, Virginia.
MD
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Ashley M Shilling
Department of Anesthesiology, University of Virginia Health Science System, Charlottesville, Virginia.
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  • Article
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Article Figures & Data

Figures

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  • Fig. 1.
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    Fig. 1.

    Suggested letter to be given to a patient with a difficulty airway experience to be shared with future caregivers, who then can use this information to prepare for and prevent future tragedies. DOB = date of birth. LMA = laryngeal mask airway. Courtesy the Anesthesia Patient Safety Foundation.

  • Fig. 2.
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    Fig. 2.

    This subject demonstrates an wide oral opening and stable dentition.

  • Fig. 3.
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    Fig. 3.

    The normal profile of this subject suggests that his mandibular length is adequate and that manual ventilation and intubation should not be difficult.

  • Fig. 4.
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    Fig. 4.

    Thyromental and sternomental distances are measured with the subject performing maximal head extension.

  • Fig. 5.
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    Fig. 5.

    Lip bite test is demonstrated. Since the subject can place his lower teeth at or above the upper vermilion line, adequate jaw movement should permit intubation using direct laryngoscopy.

  • Fig. 6.
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    Fig. 6.

    This subject illustrates the classic sniffing head position, which is optimal for intubation. It also allows for more effective manual ventilation in most situations.

  • Fig. 7.
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    Fig. 7.

    Pre-anesthesia checklist. NPO = nil per os (nothing by mouth). Courtesy the Anesthesia Patient Safety Foundation.

  • Fig. 8.
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    Fig. 8.

    Difficult airway algorithm developed and modified by the American Society of Anesthesiologists. LMA = laryngeal mask airway. From Reference 38, with permission.

  • Fig. 9.
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    Fig. 9.

    Comparison of 2 methods of preoxygenation. Data from Reference 40.

  • Fig. 10.
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    Fig. 10.

    Cormack-Lehane grades.

  • Fig. 11.
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    Fig. 11.

    Mallampati view of the patient discussed in the case study.

  • Fig. 12.
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    Fig. 12.

    Note dictated and entered into the medical record of the patient in the case study. LMA = laryngeal mask airway.

  • Fig. 13.
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    Fig. 13.

    The cause of the intubation difficulty in the case study was massive mandibular tori.

  • Fig. 14.
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    Fig. 14.

    A difficult-airway warning band was placed on the patient, alerting hospital caregivers of the potential airway problem.

Tables

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In this issue

Respiratory Care: 59 (6)
Respiratory Care
Vol. 59, Issue 6
1 Jun 2014
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Elective IntubationDiscussion
Charles G Durbin, Christopher T Bell, Ashley M Shilling
Respiratory Care Jun 2014, 59 (6) 825-849; DOI: 10.4187/respcare.02802

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Elective IntubationDiscussion
Charles G Durbin, Christopher T Bell, Ashley M Shilling
Respiratory Care Jun 2014, 59 (6) 825-849; DOI: 10.4187/respcare.02802
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  • Article
    • Abstract
    • Introduction
    • Intubation: Perioperative Versus Outside the Operating Room
    • Preparing for Intubation
    • Intubation Using Direct Laryngoscopy
    • Alternative Airway Plans
    • Postintubation Plans
    • Transfer of Care
    • Conclusions
    • Footnotes
    • References
    • Hurford:
    • Durbin:
    • Hurford:
    • Davies:
    • Durbin:
    • Davies:
    • Ramachandran:
    • Durbin:
    • Collins:
    • Napolitano:
    • Durbin:
    • Davies:
    • Napolitano:
    • Durbin:
    • Ramachandran:
    • Durbin:
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    • Haas:
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    • References
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Keywords

  • tracheal intubation
  • manual ventilation
  • artificial airway
  • endotracheal tube
  • difficult airway
  • difficult intubation
  • airway emergency
  • direct laryngoscopy
  • fiberoptic intubation

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