ANALISA VIDEO

1. Intubation Procedure

Sumer rujukan: https://www.youtube.com/watch?v=GeNG1M9eC-E

Intubation the Patient

Positioning the Patient

1. The head is position so there is flexed at the lower cervical spine (C6-C7) and
extension at the upper cervical spine (C1-C2)

This is the position we get the patient in before we intubate so we try to flex at
the lower cervical spine so down at c6 7 fleks forward and then extend at c1 2
and this is known as the sniffing position and you have to adjust that pillow
onto the head sometimes underneath the shoulders to lift the shoulders to
improve the extension to get a good airway you should always have something
under the head one of the fallacies of people who don’t intubate frequently
that they throw the pillow across the room to get it out of the room and then an
anesthesiologist has to come in and put it back and injured the patient

2. Note that the laryngoscope blade is placed on the right side of the tongue, the
tongue is swept to the left, and the laryngoscope blade is elevated to show the
vocal cords.

The laryngoscope is placed on the right side of the mouth avoiding touching
the teeth is pulls the tongue to the midline
3. The wrist must remain rigid during the laryngoscopy
It’s lifted it’s never ever do you turn your wrist when you’re doing this you
put the lingering scope in and you lift and the lifting lifts the tongue and the
mandible and allows the cords to be seen and you can see in this example the
cords are very easy to see and that’s a dream intubation that’s going to be very
easy to do. So in this situation you can see how difficult you can see how
difficult you can make things by positioning the patient incorrectly

Aligning the axes

1. The neck is too flexed

In the picture on the left the patient doesn’t have a pillow I just finished
mentioning how important that is but you can see what’s happened here is the
next two flexed the lower part of the neck is kind of pushed forward and you
can’t get good atlanto-occipital extension
2. The axis from brow to chest wall should be a straight line for ideal intubating
conditions
 In the second picture it’s better and there should be a fairly straight line from
the mouth down the aiway and that you can see
3. The neck is too extended
In the third picture there’s a fairly good view but it could be argued that this is
too extended that they’ve extended the whole neck rather than just the Atlanta
occipital area

Proper position for the laryngoscope

Position for Mackintosh blade and Miller blade

a. The Mackintosh blade (curved) should be positioned anterior to the epiglottis

in the valeculae and should not contact the epiglottis while lifting

So the Masintosh blade the curved blade should be positioned anterior to the
epiglottis in the vallecula that’s epiglottis in the vallecula that’s the base of the
tongue and should not contact the epiglottis

b. The Miller blade (straight) should be posterior to the epiglottis and should
contact the epiglottis while lifting

The Miller blade the straight blade on the other hand actually lifts the
epiglottis and you can see that in the picture to the right of the Macintosh
blade it actually lifts the epiglottis and there’s some hemodynamic changes
that can occur when you do that particularly vagal stimulation so you can get
 braddock Ardea and things that I just as soon avoid so I don’t use a straight
blade.

Translate

Intubasi pasien

Memposisikan pasien

1. Posisikan kepala hingga tertekuk di tulang belakang servikal bawah (C6-C7)

dan perpanjangan di tulang belakang servikal atas (C1-C2)
Ini adalah posisi yang kita dapatkan pada pasien sebelum kita intubasi
sehingga kita mencoba untuk menempatkan di bagian bawah tulang belakang
serviks sehingga turun di C6 7 tempatkan ke depan dan kemudian
memperpanjang di C1 2 dan ini dikenal sebagai posisi sniffing dan anda harus
menyesuaikan bantal di kepala kadang di bawah bahu untuk mengangkat bahu
sehingga meningkatkan ekstensi untuk mendapatkan jalan nafas yang baik.
Harus selalu ada sesuatu di bawah kepala, yaitu salah satu dari kesalahan
orang yang tidak intubasi sering melepaskan bantal di ruangan untuk diambil
kembali dan anestesi harus datang dan memasukkannya kembali dan melukai
pasien
2. Perhatikan bahwa pisau laryngoscope ditempatkan di sisi kanan lidah, lidah
menyapu ke kiri, dan pisau laryngoscope ditinggikan untuk menunjukkan pita
suara.

Laringgoskop ditempatkan di sisi kanan mulut menghindari menyentuh gigi

menarik lidah ke garis tengah

3. Pergelangan tangan harus tetap kaku selama laringoskopi

Laringoskop ini mengangkat, jangan pernah mengubah pergelangan tangan

ketika melakukan ini harus menaruh lama sampai mengangkat dan mengangkat
lidah kiri dan mengangkat mandibula yang memungkinkan tali untuk dilihat
dan Anda dapat melihatnya. Dalam contoh ini tali sangat mudah untuk dilihat
dan intubasi akan sangat mudah untuk dilakukan. Dalam situasi ini, dapat
dilihat betapa sulitnya membuat sesuatu dengan memposisikan pasien secara
tidak benar

Menyejajarkan sumbu

1. Leher terlalu ditekuk

 Dalam gambar di sebelah kiri pasien tidak memiliki bantal aku baru saja
selesai menyebutkan betapa pentingnya itu tetapi Anda dapat melihat apa yang
terjadi di sini
2. Sumbu dari alis ke dinding dada harus garis lurus untuk kondisi intubasi yang
ideal
Tertekuk bagian bawah leher karena didorong ke depan dan Anda tidak bisa
mendapatkan baik atlanto-occipital axtension dalam gambar kedua lebih baik
dan harus ada garis lurus yang cukup dari mulut ke bawah jalan nafas dan
bahwa Anda dapat melihat
3. Leher terlalu diperpanjang

Di gambar ketiga ada pandangan yang cukup baik tapi bisa berpendapat
bahwa ini terlalu diperpanjang karena telah memperpanjang seluruh leher
bukan hanya daerah oksipital Atlanta

Posisi yang tepat untuk laryngoscope

Posisi untuk pisau Mackintosh dan pisau Miller

1. Pisau Mackintosh (melengkung) harus diposisikan anterior epiglotis di

valeculae dan tidak boleh menghubungi epiglotis saat mengangkat

Pisau Masintosh pisau harus melengkung diposisikan anterior epiglotis di

Vallecula yang dasar lidah dan tidak boleh menghubungi epiglotis
2. Pisau Miller (lurus) harus posterior epiglotis dan harus menghubungi epiglotis
saat mengangkat

Pisau Miller (pisau lurus) di sisi lain yang seharusnya mengangkat epiglotis
dan Anda dapat melihat bahwa dalam gambar di sebelah kanan Macintosh
Blade sebenarnya mengangkat epiglotis dan ada beberapa perubahan
hemodinamik yang dapat terjadi ketika Anda melakukan stimulasi vaga
(stimulasi saraf vagus) sehingga Anda bisa mendapatkan Ardea baddock dan
hal yang saya hanya segera menghindari jadi saya tidak menggunakan pisau
lurus.

SUMBER RUJUKAN LAIN

VIDEO KE 2

Di Slide

Physiologic Basics of Anesthesiology

Does general anesthesia have an impact upon respiratory function?

Ansthetic vapours?

1. Anesthetic vapors reduce the breathing center’s response to changes in

PaCO2 (partial pressure a carbon dioxide in blood)
2. Vapors increase rate of breathing (RR) but decrease tidal volume (TV)
thus reducing overall minute ventilation
3. This has the effect of allowing carbon dioxide to rise in the blood
4. Extreme cases, oxygen level drop may result in hypoxemia

Opioids (and opiates)?

1. Also reduce brain’s response to rising carbon dioxide in the blood

 2. BUT: increase tidal volume and dramatically decrease respiratory rate thus
reducing minute ventilation
3. This also allows carbon dioxide level to rise in the blood and, in the
extreme, causes apnea (total cessation of breathing)

Kakek kakek tua ngomong:

Anesthesiology in this lecture we’re going to talk about some of the effects that
anesthetics have on basic body functions we’re going to emphasize effect the
respiratory system and the cardiovascular system and then briefly cover effects of
the hemostatic system and the acid-base balance so does general anesthesia have
an impact upon respiratory function anesthetic vapors reduced the breathing
centers response to change in arterial carbon dioxide or partial pressure carbon
dioxide in the blood vapors increased the rate of breathing but decreased tidal
volume and the overall effect is to reduce minute ventilation this has the effect of
allowing carbon dioxide to rise in the blood. In extreme cases very extreme cases
oxygen level may also drop resulting in hypoxemia or low blood oxygen and
reduction in the general oxygen delivery to tissues opiates and opioids also have a
major effect upon the respiratory system they also reduce the brains response to
the rising carbon dioxide in the blood but the increase in tidal volume but they
increase the title volume dramatically and decrease respiratory rate thus reducing
minute ventilation so they work exactly the opposite of how vapors work the
overall effect however is still to allow carbon dioxide to rice which under normal
circumstances would have a major stimulating effect upon the respiratory center
however the presence of vapors or opiates interferes with that response from the
respiratory center so carbon dioxide continues to rise and does not stimulate more
breathing so how do we take care of these changes we can assist the patient’s
breathing by simply applying more ventilation through a bag and mask or through
intubating the patient and using a ventilator and we can increase the minute
ventilation very easily through that process