What techniques are also increasingly used in the treatment of respiratory tract, the respiratory volume was 6-8 ml (significantly less than previously recommended) and respiration rate (recommended significantly slower than earlier in order to avoid negative hemodynamic consequences) 8-10 breaths / min amount ,

The treatment of respiratory tract consists of the cleaning of the upper portions of the respiratory tract, the restoration of a free air supply by means of ventilation aids and occasionally assisted ventilation. There are numerous indications for airway (s. Situations that require you to secure the airways) and many methods for restoring an airway. What techniques are also increasingly used in the treatment of respiratory tract, the respiratory volume was 6-8 ml (significantly less than previously recommended) and respiration rate (recommended significantly slower than earlier in order to avoid negative hemodynamic consequences) 8-10 breaths / min amount , Situations that require a backup respiratory classification examples emergency cardiac arrest apnea or apnea (z. B. in CNS disorders, the influence of drugs or hypoxia) Deep coma with sinking back of the tongue, thus laying the glottis Acute laryngeal laryngospasm foreign objects in the larynx (eg. B. Bolustod) drowning trauma to the upper airway high cranial or spinal cord injury emergencies respiratory failure need for respiratory assistance (eg. as in ARDS, inhalation of smoke or tox ischer Noxen, burns of the respiratory tract, aspiration of gastric contents, exacerbation of COPD or asthma, diffuse infectious diseases or other parenchymal lung disease, neuromuscular disorders, depression of the respiratory center or extreme fatigue of the respiratory muscles) the need to reduce the work of breathing in patients in shock, reduced cardiac output or for reducing myocardial stress before gastric lavage in patients with drug overdose and clouded mental status before esophagogastroduodenoscopy in patients with upper GI bleeding before radiological measures in patients with sonsorieller restriction, especially when required sedation clearing and opening the upper front of bronchoscopy in patients with respiratory marginal clinical status Respiratory tract In order to alleviate airway obstruction caused by soft tissues of the upper respiratory tract, and to create an optimal position for ventilation with the bag-valve-mask (BVM) and for laryngoscopy, the examiner reclined the neck of the patient to raise his head until the external auditory canal is at the same level as the sternum and the face positioned approximately parallel to the ceiling is (positioning of the head and neck to the opening of the airways.). This position is a little different than the previously learned Reklination the cervical spine ( “head tilt”). The jaw should be pushed upward by the lower jaw, and the soft tissue submandibular be raised or the ramus is pressed upwards (pine handle.). All rights must be carried out as the head tilt, jaw handle and lift the chin © Elsevier Inc. reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘5279917213001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5300507250001_5279917213001-vs.jpg?pubId=3850378299001&videoId=5279917213001’, title: All rights reserved © Elsevier Inc. ‘As the head tilt, jaw handle and lift the chin to be carried out’, description: ” credits’. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Positioning of the head and neck to open up the airways. A: The head is flat on the stretcher, the airways are narrowed. B: ear and sternale pit are aligned with the face parallel to the ceiling to open the airways. Adapted from Levitan RM, Kinkle WC: The Airway Cam Pocket Guide to intubation, ed 2. Wayne (PA), Airway Cam Technologies, 2007. Kiefer handle.. Anatomical limitations, various anomalies or concerns due to trauma (eg. As Unratsamkeit, a possible broken neck to move), the ability of the examiner to perform these maneuvers, restrict, however, a careful attention to the optimal positioning can maximize the airway patency and ventilation facilitate using a BVM and laryngoscopy. Linings by dental prosthesis parts and foreign material in the oropharynx (eg., Blood, secretions) can often be removed by direct digital removal or extraction. However, it must be taken to ensure that this material is not deeper deported to the respiratory tract (this risk is greatest in infants and young children, in whom the digital manipulation is contraindicated without view). Deeply penetrated into the airways material can be removed by suction using a Magill forceps or. Heimlich maneuver (subdiaphragmatic abdominal pressure), the Heimlich maneuver consists in jerky pressure exerted on the upper abdomen or in pregnant women or extremely obese patients on the chest area, until the airway is open, or the patient is unconscious. It is the preferred initial measure in the conscious, choking patients. With awareness clear adult helper stands behind the patient and covers it with both arms approximately at the level of the upper abdomen. A fist is in this case placed at half height between the navel and the xiphoid process. The other hand grasps the thumb, and then inwardly and to exert strong cranially-directed, sudden pressure. Here, the helper pulls his arms jerkily toward you (s. Abdominal pressure compression on awake patients while standing or sitting.). In an unconscious adult patients with obstruction of the upper airways cardiopulmonary resuscitation attempt is first made. In such patients, chest compressions can increase intrathoracic pressure in the same way as does the abdominal pressure compression in conscious patients. The oropharynx should be examined before each series of breaths and all visible objects should be removed with the fingers. The direct laryngoscopy with suctioning or Magill forceps can also be used to remove a foreign body in the proximal airways, but once an object has passed the vocal cords, is positive pressure from below against the obstacle most successful. Abdominal pressure compression on awake patients while standing or sitting. Even in older children the Heimlich maneuver can be used. In children below 20 kg body weight, however, (usually before age 5) very moderate pressure must be exercised here. In addition, the rescuer should be placed here in the area of ??the child’s feet and not astride kneel on the child. In children before the age of 1, the Heimlich maneuver should not be used. The children should be face down held in a position with downside head. The head is supported with the fingers of one hand while 5 times on the back of the child suggests (beating on the back -. Child). After that, the chest of the child should be compressed 5-times. And the babe lying with his head down in a supine position on the thigh of the helper (pressure compression on the breast – child.). This series of blows to the back and chest compressions should be repeated until the airway is free. Blows to the back – child. The blows to the back be carried out in the child in a position with downside head to remove debris from the tracheobronchial region. (Adapted from Standards and Guidelines for Cardiopulmonary Resuscitation [CPR] and Emergency Cardiac Care [ECC], in: Journal of the American Medical Association 25: 2956 and 2959, June 6, 1986. Copyright 1986 American Medical Association.) Pressure compression on the breast – child. The pressure compression on the breast is performed in the lower half of the sternum, directly below the nipples. Respiratory and breathing aids, it fails to insert the spontaneous breathing after the airway and are also not breathing aids accessible, first an emergency-oriented ventilation must be started (as mouth-to-mask-or word-of-guard resuscitation). Mouth-to-mouth resuscitation is seldom recommended. Exhaled air contains 16 to 18% O2 and 4-5% CO2. This is sufficient to achieve nearly normwertige blood levels of O2 and CO2. However, if too large volumes of air insufflation, this can lead to gastric overstretching and thus be the cause of a subsequent aspiration. Bag-valve-mask systems (BVM) These devices consist of a self-inflatable bag (resuscitator) comprising a non-rebreathing valve mechanism and a soft mask, which adapts the facial shapes; if they are vebunden with an O2 source, they provide 60-100% of the inhaled O2. In the hands of an experienced practitioner sufficient ventilation is temporarily produced with the bag ventilation via mask in many situations. Thus, enough time to be saved, and then make the connection for a definitive airway. However, if the bag ventilation is used for mask> 5 min, reaches usually air in the stomach. Then, a nasogastric tube should be placed in order to vent the accumulated air. As a Oropharyngaler airway is inserted © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘4536799004001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4536799866001_4536799004001-vs.jpg?pubId=3850378299001&videoId=4536799004001’, title: ‘Like a Oropharyngaler airway is inserted’ description: ” credits’ © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); However, these instruments alone does not sufficiently secure the airway patency. Thus, for example in patients with flaccid soft tissue structures of a careful placement and manual maneuver (s. Positioning of the head and neck to open up the airways. And jaw grip.) Just as necessary as additional help in keeping open the airway. A oropharyngeal or a nasal tube used during the bag ventilation via the mask to prevent soft tissue of the oropharynx obstruct the airway. These devices cause choking when awake patients and possibly vomiting and aspiration. The devices must have an appropriate size. A oropharyngeal tube should be long enough so that it corresponds to the distance between the mouth and the angle of the jaw of the patient. As a nasopharyngeal airway is inserted © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘4536776218001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4536797451001_4536776218001-vs.jpg?pubId=3850378299001&videoId=4536776218001’, title: ‘Like a nasopharyngeal airway is inserted’ description: ” credits’ © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Resuscitator also be used together with respiratory aids such as endotracheal tubes and supraglottic and pharyngeal airway devices. Pediatric resuscitator have an adjustable pressure relief valve, with which the peak pressure can be limited in the respiratory tract (usually 35-45 cm H2O). The practitioner must monitor the setting of the valve to prevent inadvertent hypoventilation. How to perform bag-valve-mask ventilation is © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘5279908072001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5300515565001_5279908072001-vs.jpg?pubId=3850378299001&videoId=5279908072001’, title: ‘As bag-valve-mask ventilation is carried out’, description: ” credits’ © Elsevier Inc. All rights reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); A laryngeal mask laryngeal masks or supraglottic airway can be inserted into the lower oropharynx in order to prevent airway obstruction by soft tissues and to ensure effective ventilation channel (s. Laryngeal mask airway (LMA).). A variety of available laryngeal masks has a channel for an endotracheal or Magendekompressionstubus. As the name suggests, these devices block the larynx (instead of face masks interface), thus avoiding the difficulty of maintaining an adequate face mask seal and the risk of displacement of the jaw and tongue. Laryngeal masks have become the standard ventilation technology for situations where endotracheal intubation can not be performed, and for certain elective anesthesia and emergencies. Complications include vomiting and aspiration in patients who have an intact gag reflex and / or receive excessive ventilation. There are numerous techniques for conditioning of laryngeal masks. The standard method is to press the mask against the hard palate not filled (with the long fingers of the dominant hand) and to turn on the tongue base over until the mask reaches the hypopharynx, so that the tip sits in the upper esophagus. Once it is in the correct position, the mask is inflated. The inflation of the mask with half the recommended amount before inserting stiffens the tip, potentially facilitates insertion. Newer versions replace the inflatable cuff by a gel, which takes the form of the respiratory tract. As a laryngeal mask is inserted method demonstrated by Chad Smith, MD, EM-2 Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York Hospital Emergency Medicine Residency Program York, PA carcass samples filmed provided by the Maryland State Anatomy Board, DHMH in the School of Medicine, Anatomical Services Division, Univ. Maryland var model = {videoId: ‘5474233645001’ playerId: ‘H1xmEWTatg_default’ imageUrl: ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5474231901001_5474233645001-vs.jpg?pubId=3850378299001&videoId=5474233645001’ title: method demonstrated by Chad Smith, MD, EM-2 Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York hospital Emergency Medicine Residency Program York, ‘Like a laryngeal mask is inserted’ description: ” credits’ PA carcass samples provided by the Maryland State Anatomy Board, DHMH filmed in the School of Medicine, Anatomical Services Division, Univ. Maryland ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Although the laryngeal mask airways not isolated from the esophagus as an endotracheal tube, it has some advantages over bag ventilation via mask that minimize the distension of the stomach and provides some protection from passive regurgitation. can be introduced by a tube to decompress the stomach Newer versions of laryngeal masks have an opening. The effectiveness of the seal by a laryngeal mask airway does not correlate directly with the air pressure in the mask, unlike the endotracheal tube. When an endotracheal tube of the higher pressure causes balloon closer seal; at a laryngeal mask the hyperinflation makes the mask stiffer and less able to adapt to the patient’s anatomy. If the seal is not sufficient, the mask pressure should be lowered somewhat. If this approach does not work, an attempt with a larger mask should be taken. In emergencies laryngeal masks should be considered as a technique for bridging. Longer placement and / or distension of the mask compress the tongue and cause a tongue edema. Although nichtkomatösen patients are given before the onset of laryngeal mask airway (eg. As a laryngoscopy) muscle relaxants, they can choke and may aspirate if the effect of these drugs wears off. Either the device should be removed (assuming that respiration and Würgereflexe are sufficient), or it should be given medication to eliminate the gag reflex and time for an alternative intubation to win. Laryngeal mask airway (LMA). The laryngeal mask is made of a tube with an inflatable cuff which is inserted into the oropharynx. A: The non-filled sleeve is inserted into the mouth. B: Using the index finger, the sleeve is brought into position above the larynx. C: Once in place the cuff is inflated. Some recent cuffs instead of using an inflatable cuff, a gel, which takes the form of the respiratory tract. Endotracheal tube An endotracheal tube is directly inserted via the mouth or, more rarely, through the nose into the trachea. Large endotracheal tubes have Cuffs with high filling volumes at low balloon pressure to prevent air leakage and minimize the risk of aspiration. Were tubes with Cuffs usually only used in adults and children> 8 years, find they now also increasingly in infants and younger children use to prevent leaks (especially in transportation). Occasionally, the cuffs are not inflated or only to the extent inflated, which is required to prevent significant leakage. An endotracheal tube is the definitive way to save an endangered airway to protect against aspiration and initiate mechanical ventilation in comatose patients, and also in patients who can not protect their own airway, and for those who require longer mechanical ventilation. After endotracheal intubation also a suction and lower respiratory sections is possible. Although drugs can be administered through an endotracheal tube during a cardiac arrest is to refrain from this practice. The placement typically requires a laryngoscopy by a specialist, but a variety of new devices that offer more options is increasing, Verfügung.Andere equipment Another class of respirators are Larynxtubus- or twin-lumen airway devices (eg. As Combitube ®, King LT). These devices use the balloon 2 in order to create below the larynx and a seal over, and have ventilation ports above the laryngeal opening (located between the balloons). As with the laryngeal masks a longer placement and hyperinflation of the balloon can lead to tongue edema. How to introduce a combined esophageal tracheal probe method is demonstrated by Walter Schrading, MD, FACEP Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York Hospital Emergency Medicine Residency Program York, PA carcass samples provided by the Maryland State Anatomy Board , DHMH filmed in the School of Medicine, Anatomical Services Division, Univ. Maryland var model = {videoId: ‘5474227386001’ playerId: ‘H1xmEWTatg_default’ imageUrl: ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5474231319001_5474227386001-vs.jpg?pubId=3850378299001&videoId=5474227386001’ title: method demonstrated by Walter Schrading, MD, FACEP Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York hospital Emergency Medicine Residency ‘How to introduce a combined esophageal tracheal probe’ description: ” credits’ Program York, PA carcass samples provided by the Maryland State Anatomy Board, DHMH filmed in the School of Medicine, Anatomical Services Division, Univ. Maryland ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); “King Tube Placement” Video created by Hospital Procedures Consultants, www.hospitalprocedures.org. var model = {videoId: ‘4888683188001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4888762091001_vs-57334516e4b02300f2f60f22-4704275687001.jpg?pubId=3850378299001&videoId=4888683188001’ title: ‘ “King Tube placement ‘”, description: ” credits ‘video created by Hospital Procedures Consultants, www.hospitalprocedures.org’ hideCredits. true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true }; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Endotracheal intubation Most patients who require mechanical ventilation, can be treated with an endotracheal intubation. The orotracheal intubation, typically carried out by a direct laryngoscopy is in this case given especially in apneic and critically ill patients preference. The reason for this is usually the faster compared to nasotracheal intubation feasibility. The latter is rather reserved for sufficiently awake and spontaneously breathing patient or for cases where the mouth should be avoided. Orotracheal intubation video created by Hospital Procedures Consultants, www.hospitalprocedures.org. var model = {videoId: ‘3903698689001’, playerId ‘SyAEZ6ptl_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4412104071001_vs-55c8fc7ee4b097d1c2d52154-1592194027001.jpg?pubId=3850378299001&videoId=3903698689001’ title: ‘orotracheal intubation’ description: ” credits ‘video created by Hospital Procedures Consultants, www.hospitalprocedures.org’ hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Process is carried out as orotracheal intubation with video laryngoscopy demonstrated by David Konopka, MD Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York Hospital Emergency Medicine Residency Program York, PA filmed carcass samples provided by the Maryland State Anatomy Board, DHMH in the School of Medicine, Anatomical Services Division, Univ. Maryland var model = {videoId: ‘5474222274001’ playerId: ‘H1xmEWTatg_default’ imageUrl: ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5474232695001_5474222274001-vs.jpg?pubId=3850378299001&videoId=5474222274001’ title: method demonstrated by David Konopka, MD Walter A. Schrading, MD, FACEP, faculty supervisor WellSpan York hospital Emergency Medicine Residency Program York, ‘How orotracheal intubation with video laryngoscopy is carried out’, description: ” credits’ PA carcass samples provided by the Maryland State Anatomy Board, DHMH filmed in the School of Medicine, Anatomical Services Division, Univ. Maryland ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true}; var pane

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