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Wednesday, January 09, 2008

Pneumothoraxis not an indication for endotracheal intubation

022 Which of the following is not an indication for endotracheal intubation?

1. Maintenance of a patent airway

2. To provide positive pressure ventilation

3. Pulmonary toilet

4. Pneumothorax

Answer

4. Pneumothorax

Reference

Sabiston 15th Edition Chapter 17

Quality

Reader

Status

Repeat

QTDF

All books give this

Discussion

INDICATIONS FOR ENDOTRACHEAL INTUBATION

Indications for ENDOTRACHEAL INTUBATION in the operating room include:

  • the need to deliver positive pressure ventilation
  • protection of the respiratory tract from aspiration of gastric contents
  • surgical procedures involving the head and neck or in non-supine positions that preclude manual airway support
  • almost all situations involving neuromuscular paralysis
  • surgical procedures involving the cranium, thorax, or abdomen
  • procedures that may involve intracranial hypertension

Some non-operative indications are:

  • profound disturbance in consciousness with the inability to protect the airway
  • tracheobronchial toilet
  • severe pulmonary or multisystem injury associated with respiratory failure, such as sepsis, airway obstruction, hypoxemia, and hypercarbia

Explanation

Self Explanatory

Comments

Objective measures may also be used to help determine the need for intubation:

  • respiratory rate > 35 breaths per minute
  • vital capacity <>
  • inability to generate a negative inspiratory force of 20 mm Hg
  • PaO2 (arterial partial pressure of oxygen) <>
  • A-a gradient (Alveolar-arterial) > 350 mm Hg on 100% oxygen
  • PaCO2 (arterial partial pressure of carbon dioxide) > 55 m Hg (except in chronic retainers)
  • dead space > 0.6 L

Tips

Alternative techniques to establish an airway

* Oral Airway

* Nasal Airway

* Mask Ventilation

* Transtracheal Jet Ventilation

* Retrograde Intubation

* Laryngeal Mask Airway

* Light Wand

* Blind Nasal Intubation

* Combitube

* Emergency Cricothyrotomy Devices

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