usually simply referred placement flexible plastic tube maintain open serve administer certain drugs frequently performed critically injured ill patients facilitate ventilation lungs including mechanical ventilation prevent possibility widely route tube passed mouth vocal apparatus procedure tube passed nose vocal apparatus methods involve surgery include exclusively emergency circumstances primarily situations prolonged need support anticipated invasive uncomfortable medical procedure usually performed administration general blocking drug performed awake patient local emergency normally facilitated conventional flexible video identify vocal pass tube instead devices techniques alternatively balloon typically inflated far end tube help secure place prevent respiratory gases protect tree receiving undesirable material stomach acid tube secured face neck connected piece breathing circuit bag valve mask device mechanical longer need assistance protection tube removed referred case surgical centuries considered reliable method minority patients survived operation physicians undertook resort patients nearly dead late 19th century advances understanding anatomy physiology appreciation theory disease improved outcome operation point considered acceptable treatment option time advances instrumentation improved degree direct viable means secure non surgical route mid-20th century non surgical evolved rarely employed procedures essential components practices critical care medicine emergency medicine associated minor complications broken teeth tissues upper associated potentially fatal complications stomach contents result severe fatal chemical lead potentially fatal potential difficulty complications presence unusual anatomy carefully evaluated undertaking alternative strategies securing readily available indications indicated variety situations illness medical procedure prevents person maintaining clear breathing blood circumstances oxygen simple face mask inadequate depressed level consciousness common indication placement volatile administered general agents blocking drugs diminish abolish respiratory drive means maintain patent general provides reliable means ventilation greatest degree protection damage brain massive stroke non penetrating head injury poisoning result depressed level consciousness severe point coma defined score glasgow coma scale dynamic collapse muscles free flow air lungs furthermore protective diminished absent required restore relative absence protect tree contents necessary patient decreased oxygen content oxygen blood caused breathing inadequate suspended lungs unable sufficiently transfer blood patients awake alert typically critically ill disease multiple severe injuries examples conditions include spine injury multiple rib severe pneumonia acute respiratory distress syndrome near drowning specifically considered arterial partial pressure oxygen millimeters mercury breathing inspired concentration greater patients elevated arterial carbon dioxide arterial partial pressure greater setting prompt especially series measurements demonstrate respiratory regardless laboratory values guidelines interpreted clinical context actual impending common indication life threatening occur foreign body lodged especially common severe blunt penetrating injury face neck accompanied swelling expanding injury common people suffered smoke burns near sustained seizure activity common causes life threatening require secure manipulation manipulation laser therapy intermittently interfere ability breathe necessary situations equipment vast majority involve use viewing instrument type modern conventional consists handle containing batteries power light set blades straight curved device designed allow directly view widespread availability devices technique blind rarely practiced today useful certain emergency situations natural man disasters emergency setting digital necessitated patient position makes direct impossible example digital patient inverted position vehicle motor vehicle collision prolonged time decision use straight curved blade depends partly specific features partly personal experience preference blade widely curved blade miller blade popular style straight blade miller blades available sizes infant large adult styles straight curved blades accessories mirrors field view ports administration oxygen specialty blades primarily designed use commonly operating room increasingly available 1990s contrast conventional devices allow indirectly view provides significant advantage situations operator needs acute bend order deal difficult video specialized use digital video camera allow operator view video monitor devices employed assist mask tube placement metal wire designed inserted tube tube conform better upper anatomy specific individual aid commonly difficult blades types available specifically designed follow blade angle video tube incorrectly referred elastic specialized type facilitate difficult flexible device length french diameter small hockey stick angle far end unlike traditional tube typically inserted directly guide tube passed manner analogous technique tube considerably rigid conventional technique considered relatively means tube hollow length removal replacement tubes need example type device central hollow channel oxygen administered device employs principle facilitate blind technique view tubes tube inserted primary purpose establishing maintaining patent open tubes frequently management settings general critical care mechanical ventilation emergency medicine different types tubes available suited different specific applications tube specific type tube nearly inserted mouth nose breathing designed placed critically injured ill patients order perform mechanical positive pressure ventilation lungs prevent possibility tube fitting designed connected source gas oxygen end gases directed lungs include balloon referred tip tube positioned divides lung sealed lungs equally tube type tube inch long curved metal plastic tube inserted tubes ensure adequate exchange oxygen carbon dioxide deliver oxygen higher concentrations found air administer gases certain volatile agents route administration certain drugs treating cardiac arrest originally latex rubber modern tubes today constructed tubes constructed rubber wire reinforced rubber steel available special applications human use tubes range size internal diameter size chosen based patient body size smaller sizes children tubes seal tree respiratory gases contents blood tubes available use limited children small children portion usually provides adequate seal mechanical ventilation addition tubes available oral nasal tubes named ring widely tubes number different types double tubes channels tubes tubes typically separate channels separate openings incorporate terminates tip positioned right left tube single integrated tubes enable lungs lung independently single lung ventilation allowing lung operative collapse useful surgery facilitate surgeon view access relevant structures cavity armored tubes wire reinforced rubber tubes flexible tubes difficult useful situations anticipated remain prolonged duration neck remain surgery armored tubes curve armored tubes available type tube small openings administration necessary tubes tube designed specifically use laser surgery methods confirm tube placement single method confirming tube placement shown reliable accordingly use multiple methods confirmation correct tube placement widely considered standard care methods include direct tip tube passes indirect tube device properly positioned tube equal breath sounds heard listening chest sound listening area stomach equal rise fall chest wall evident small water evident tube contents tube time methods utilized confirming tube placement measuring instrument emerged gold standard confirmation tube placement methods relying instruments include use end tidal carbon dioxide self detection device tip properly positioned tube located mid roughly confirmed chest ray inserted far tip tube likely right main situation referred right situation left lung unable participate ventilation lead decreased oxygen content ventilation special situations emergency setting difficult blood poor patient cooperation patients massive facial injury complete upper severely diminished ventilation upper bleeding poor candidates general typically requires skilled individuals success rates reported techniques emergency department significant nasal bleeding occurring patients limit use somewhat urgent emergency situations personnel experienced direct immediately available certain settings require emergency reason specialized devices designed act bridges definitive devices include mask devices rigid blind technique indirect rigid scope scope alternatives direct devices unique set benefits effective circumstances rapid sequence induction rapid sequence induction particular method induction general commonly employed emergency operations situations patients assumed stomach objective minimize possibility contents induction general subsequent traditionally involves lungs tightly fitting oxygen mask followed administration sleep inducing agent rapidly acting blocking drug important difference routine manually assist ventilation lungs onset general cessation breathing inflated key feature application manual pressure referred maneuver prior instrumentation introduction controversy virtually aspect technique including choice induction drug dose method administration avoidance manual ventilation optimal position head head horizontal position induction stomach patients application pressure maneuver named british described procedure goal pressure minimize possibility contents pressure widely nearly years despite lack compelling evidence support practice initial article based small sample size time high tidal volumes head positioning rule beginning significant body evidence accumulated questions effectiveness pressure application pressure fact displace instead described pressure view actually cause delay securing pressure confused maneuver involve digital pressure anterior aspect apparatus purpose improve view prevent pressure maneuver potential emergency situations patient conscious respiratory failure imminent extreme trauma procedure commonly performed flight flight use transport moving fixed wing wing aircraft extremely difficult perform environmental factors patient paralyzed ground transport aircraft skin membrane establish patent certain life threatening situations foreign body massive facial trauma nearly performed resort cases impossible easier quicker perform require manipulation spine associated fewer complications easiest method perform technique needle referred large bore gauge membrane oxygen administered jet needle life saving extreme circumstances technique intended measure definitive established needle provide adequate small diameter insufficient elimination carbon dioxide ventilation hour needle expect greater arterial despite oxygen greater definitive established performing surgical tube tube inserted larger manufacturers market kits enable use wire guided technique classic surgical technique insert membrane kits stocked hospital emergency departments operating selected pre hospital settings consists making neck opening direct resulting opening serve independently site tube inserted tube allows person breathe use nose mouth opening needle referred surgical techniques respectively techniques widely current practice order limit risk damage nerves nerves control performed high possible nerves damaged patient voice impaired nerves damaged patient unable speak acute setting indications similar chronic setting indications include need long term mechanical ventilation removal patients extensive surgery involving head neck children significant differences anatomy respiratory physiology children adults taken careful consideration performing patient differences significant gradually disappear human body approaches mature age body mass index young children easier route carries risk nasal bleeding despite greater difficulty route children undergoing intensive care requiring prolonged route allows secure tube adults number devices specially designed assistance difficult children confirmation proper position tube accomplished adult patients child narrow small swelling produce critical tube large relative diameter cause swelling conversely tube small result inability achieve effective positive pressure ventilation escape gas mouth nose referred leak tube excessive leak usually corrected larger tube tube tip correctly positioned tube mid chest correct diameter tube results small leak pressure water appropriate inner diameter tube estimated roughly diameter child little finger appropriate length tube estimated doubling distance corner child mouth ear canal premature internal diameter appropriate size tube normal age internal diameter appropriate size normally children year age older estimate appropriate diameter depth internal diameter tube patient age years appropriate depth patient age years free flow oxygen recommended evidence benefit guidelines longer predicting difficulty simple procedure consequences failure grave patient carefully evaluated potential difficulty complications involves taking medical history patient performing physical examination results scored classification systems proposed surgical procedure surgery involving head neck surgery lead difficulties individuals unusual anatomy limited movement neck jaw deep swelling injury developmental jaw excess tissue face neck conventional techniques difficult impossible patients persons performing familiar alternative techniques securing use flexible similar devices preferred techniques management cases devices require different skill set employed conventional expensive purchase maintain repair taking patient medical history subject questioned significant signs symptoms difficulty speaking difficulty breathing suggest locations upper tree history previous surgery previous fusion injury radiation therapy involving head neck upper chest provide clues potentially difficult previous experiences especially difficult prolonged duration intensive care unit prior noted detailed physical examination important particularly range motion spine subject able tilt head forward chin touches chest range motion jaw joint subject fingers able fit upper lower size shape upper jaw lower jaw looking especially problems upper jaw small jaw upper lower jaw distance subject fingers able fit adam apple chin size shape tongue relative size mouth teeth especially noting presence prominent loose damaged teeth crowns classification systems developed effort predict difficulty including classification system score score drawn observation size base tongue influences difficulty determined looking anatomy mouth particular visibility base pillars soft medical scoring systems aid evaluation patients single score combination scores trusted specifically detect patients difficult furthermore study experienced widely classification system found score patients consistently time correctly define grades widely classification system certain emergency circumstances severe head trauma suspected spine injury impossible fully utilize physical examination classification systems predict difficulty cases alternative techniques securing readily available complications generally considered best method management wide variety circumstances provides reliable means ventilation greatest degree protection requires great deal clinical experience master complications result properly performed features present straightforward adequate mouth opening range motion joint sufficient space determined examining mouth sufficient space distance chin space tongue displaced order view adequate extension spine joint way compromised expected difficult minor complications common tube typically short duration sore throat lips structures upper fractured teeth nasal injury complications common potentially include accelerated irregular high blood pressure elevated pressure complications include contents foreign bodies fracture spine joint decreased oxygen content elevated arterial carbon dioxide vocal cord weakness addition complications nasal route carries risk potentially severe nasal bleeding newer technologies flexible fared better reducing complications frequent cause trauma remains lack skill complications severe long lasting permanent vocal cord damage nerve injury immediately life threatening negative pressure fluid lungs accidental tube potentially fatal complications associated prolonged include abnormal communication nearby structures significant complications include loss associated pneumonia pressure monitored carefully order avoid complications inflation traced excessive pressure restricting blood supply spanish study reported overall rates procedural mortality comparable series reported literature netherlands united_states inability secure subsequent failure ventilation life threatening immediately corrected leads decreased oxygen content brain damage collapse death performed associated complications rapidly fatal adequate training experience complications high case widely known case patient lack oxygen suffered severe brain damage died example united_states urban communities reported common basic emergency medical technicians permitted reported success rates low study nearly half patients tubes died emergency room recent editions emphasized role favor management techniques bag valve mask ventilation mask common frequent hands inexperienced personnel likely result fatal outcome cases oxygen inadvertently administered stomach taken system instead lungs situation immediately identified corrected death cerebral cardiac claims closed claims project database approximately injury cases injuries temporary permanent resulted death difficult age older years female gender associated claims early signs present claims late occurred alternatives offers greatest degree protection means maintain patent alternative techniques management delivery oxygen volatile breathing gases include mask continuous positive pressure mask nasal mask simple face mask nasal general administered selected cases procedure brief duration procedures depth sufficient cause significant compromise function longer duration invasive procedures general administered provided patients carefully selected risk benefit ratio favorable risks associated unprotected believed risks history earliest known depiction found egyptian dating page egyptian medical dates roughly makes reference described sanskrit text medicine written ancient india text indian medicine surgery mentions credited physician perform non emergency clarified anatomy demonstrate generates voice experiments lungs dead animal described use facilitate breathing volume medical encyclopedia canon medicine 12th century medical textbook known provided correct description operation detailed descriptions subsequent artificial animals brussels landmark book published described experiment passed reed dying animal opened maintained ventilation blowing reed intermittently successfully treated patient suffering published account operation identified recorded successful despite previous references operation end 16th century described useful technique writings actually performed operation introduce idea tube french surgeon published report successful performed drowning victim despite recorded instances use antiquity early 19th century finally began recognized legitimate means treating severe french physician presented series performed treatment performed chronic performed paris public hospital overall survival rate compares patients private practice fared better greater care german surgeon published paper describing successful human performed purpose administration general sir published book discussing indications early 20th century life saving treatment patients afflicted required mechanical ventilation philadelphia described technique day non surgical techniques spanish singing teacher named man view functioning living human french developed new technique non surgical bypass resulting related scottish surgeon reported use alternative allow patient breathe setting general berlin described direct vocal modified purpose called device report high rate success use direct means jackson introduced new blade incorporated component operator slide allow room passage tube new_york surgeon published results achieved recently developed pioneer field sir developed technique awake blind blade administration volatile agents curve tube named sir introduced curved blade blade remains day widely blade optical engineers built earlier work developing optical fiber technology applied early produce flexible initially upper device english concept replacing exchanging tubes introduced central mid-1980s flexible instrument communities digital revolution 21st century brought newer technology art science manufacturers developed video employ digital technology active generate view
Tracheal intubation