i think everybody know this......... - troy

[ArchivalUser]

An 86-year-old woman is brought to the emergency department by her daughter because of a 3-day history of increasing shortness of breath, a cough, and fever. She has had a copious amount of rust-brown sputum, nearly 3 tablespoons per day. She has also had decreased food and water intake over the past few weeks. A chest x-ray shows a right lower lobe pneumonia and laboratory studies show mild hyponatremia most likely from dehydration. She is admitted to the hospital for antibiotic therapy. You are called to examine her because of severe shortness of breath. Her temperature is 39.0 C (101.2 F), blood pressure is 105/70 mm Hg, pulse is 88/min, and respirations are 36/min. She appears to be in respiratory distress. According to the daughter, the patient had just eaten her dinner about 30 minutes ago. You decide that endotracheal intubation is indicated at this time. The most important adjunct maneuver during endotracheal intubation of this patient is
A. aggressive oral suctioning during laryngoscopy
B. application of cricoid pressure by an assistant
C. beginning oral anti-acid therapy prior to intubation
D. placement of a nasogastric tube for evacuation of the stomach
E. placement of an orogastric tube for evacuation of the stomach

[ArchivalUser]

bbbbbbbbb..........

[ArchivalUser]

yeaH B

[ArchivalUser]

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[ArchivalUser]

The correct answer is B. Any patient that has eaten solids or liquids within 8 hours prior to an intubation, or is a trauma patient that has eaten within 12 hours, is considered a high risk patient for aspiration. These patients require, in addition to any other intervention, cricoid pressure to minimize the risk of aspiration. The cricoid pressure must be applied by an assistant since the operator has no free hands with which to perform the maneuver.

Aggressive oral suctioning during laryngoscopy (choice A) is important to assist with visualization of the pharyngeal and laryngeal structures but in fact does little to minimize the risk of aspiration of gastric contents.

For a patient such as this, giving the patient oral anti-acid therapy prior to intubation (choice C) is not practical since she is in distress and will be unable to take oral medications without likely aspirating those.

Placement of a nasogastric tube (choice D) or orogastric tube (choice E) for evacuation of the stomach is a reasonable choice in non-emergent situations. For this patient, having her cooperate in order to place either one of these tubes is not going to be possible and would delay an urgent, if not emergent, intubation. These tubes are often used in the operating room by anesthesiologists to evacuate the stomach once the patient has been sedated.