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AuthServ / Zilux - ( for network servers & storage )
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All these distributions have no or only minor changes when compared with the original FreeBSD base system . The main difference to the original FreeBSD is that they come with pre @-@ installed and pre @-@ configured software for specific use cases . This can be compared with Linux distributions , which are all binary ... |
Besides these distributions , there are some independent operating systems based on FreeBSD . DragonFly BSD is a fork from FreeBSD 4 @.@ 8 aiming for a different multiprocessor synchronization strategy than the one chosen for FreeBSD 5 and development of some microkernel features . It does not aim to stay compatible w... |
Darwin , the core of Apple OS X , includes a virtual file system and network stack derived from the FreeBSD virtual file system and network stack , and components of its userspace are also FreeBSD @-@ derived .
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Some subscription services that are directly based on FreeBSD are :
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WhatsApp - processes 2 million concurrent TCP connections per server .
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Embedded devices and embedded device operating systems based on FreeBSD include :
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NetApp 's Data ONTAP 8.x and the now superseded ONTAP GX ( only as a loader for proprietary kernel @-@ space module )
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Netflix 's Open Connect Appliance to handle content delivery .
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The PlayStation 4 ( " Orbis OS " )
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Parts of FreeBSD were also used in PlayStation 3 .
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= = Version history = =
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= Tracheal intubation =
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Tracheal intubation , usually simply referred to as intubation , is the placement of a flexible plastic tube into the trachea ( windpipe ) to maintain an open airway or to serve as a conduit through which to administer certain drugs . It is frequently performed in critically injured , ill , or anesthetized patients to... |
The most widely used route is orotracheal , in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea . In a nasotracheal procedure , an endotracheal tube is passed through the nose and vocal apparatus into the trachea . Other methods of intubation involve surgery and include the c... |
Because it is an invasive and uncomfortable medical procedure , intubation is usually performed after administration of general anesthesia and a neuromuscular @-@ blocking drug . It can however be performed in the awake patient with local or topical anesthesia or in an emergency without any anesthesia at all . Intubat... |
After the trachea has been intubated , a balloon cuff is typically inflated just above the far end of the tube to help secure it in place , to prevent leakage of respiratory gases , and to protect the tracheobronchial tree from receiving undesirable material such as stomach acid . The tube is then secured to the face ... |
For centuries , tracheotomy was considered the only reliable method for intubation of the trachea . However , because only a minority of patients survived the operation , physicians undertook tracheotomy only as a last resort , on patients who were nearly dead . It was not until the late 19th century however that adva... |
Tracheal intubation can be associated with minor complications such as broken teeth or lacerations of the tissues of the upper airway . It can also be associated with potentially fatal complications such as pulmonary aspiration of stomach contents which can result in a severe and sometimes fatal chemical aspiration pn... |
= = Indications = =
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Tracheal intubation is indicated in a variety of situations when illness or a medical procedure prevents a person from maintaining a clear airway , breathing , and oxygenating the blood . In these circumstances , oxygen supplementation using a simple face mask is inadequate .
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= = = Depressed level of consciousness = = =
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Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which nitrous oxide or volatile anesthetics may be administered . General anesthetic agents , opioids , and neuromuscular @-@ blocking drugs may diminish or even abolish the respiratory drive . Although it is not the o... |
Damage to the brain ( such as from a massive stroke , non @-@ penetrating head injury , intoxication or poisoning ) may result in a depressed level of consciousness . When this becomes severe to the point of stupor or coma ( defined as a score on the Glasgow Coma Scale of less than 8 ) , dynamic collapse of the extrin... |
= = = Hypoxemia = = =
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Intubation may be necessary for a patient with decreased oxygen content and oxygen saturation of the blood caused when their breathing is inadequate ( hypoventilation ) , suspended ( apnea ) , or when the lungs are unable to sufficiently transfer gasses to the blood . Such patients , who may be awake and alert , are t... |
= = = Airway obstruction = = =
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Actual or impending airway obstruction is a common indication for intubation of the trachea . Life @-@ threatening airway obstruction may occur when a foreign body becomes lodged in the airway ; this is especially common in infants and toddlers . Severe blunt or penetrating injury to the face or neck may be accompanie... |
= = = Manipulation of the airway = = =
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Diagnostic or therapeutic manipulation of the airway ( such as bronchoscopy , laser therapy or stenting of the bronchi ) may intermittently interfere with the ability to breathe ; intubation may be necessary in such situations .
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= = Equipment = =
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= = = Laryngoscopes = = =
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The vast majority of tracheal intubations involve the use of a viewing instrument of one type or another . The modern conventional laryngoscope consists of a handle containing batteries that power a light and a set of interchangeable blades , which are either straight or curved . This device is designed to allow the l... |
The decision to use a straight or curved laryngoscope blade depends partly on the specific anatomical features of the airway , and partly on the personal experience and preference of the laryngoscopist . The Macintosh blade is the most widely used curved laryngoscope blade , while the Miller blade is the most popular ... |
Fiberoptic layngoscopes have become increasingly available since the 1990s . In contrast to the conventional laryngoscope , these devices allow the laryngoscopist to indirectly view the larynx . This provides a significant advantage in situations where the operator needs to see around an acute bend in order to visuali... |
= = = Stylets = = =
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An intubating stylet is a malleable metal wire designed to be inserted into the endotracheal tube to make the tube conform better to the upper airway anatomy of the specific individual . This aid is commonly used with a difficult laryngoscopy . Just as with laryngoscope blades , there are also several types of availab... |
The Eschmann tracheal tube introducer ( often incorrectly referred to as a " gum elastic bougie " ) is specialized type of stylet used to facilitate difficult intubation . This flexible device is 60 cm ( 24 in ) in length , 15 French ( 5 mm diameter ) with a small " hockey @-@ stick " angle at the far end . Unlike a t... |
The tracheal tube exchanger is a hollow catheter , 56 to 81 cm ( 22 @.@ 0 to 31 @.@ 9 in ) in length , that can be used for removal and replacement of tracheal tubes without the need for laryngoscopy . The Cook Airway Exchange Catheter ( CAEC ) is another example of this type of catheter ; this device has a central lu... |
The lighted stylet is a device that employs the principle of transillumination to facilitate blind orotracheal intubation ( an intubation technique in which the laryngoscopist does not view the glottis ) .
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= = = Tracheal tubes = = =
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A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent ( open and unobstructed ) airway . Tracheal tubes are frequently used for airway management in the settings of general anesthesia , critical care , mechanical ventilation and emergency medic... |
Tracheal tubes can be used to ensure the adequate exchange of oxygen and carbon dioxide , to deliver oxygen in higher concentrations than found in air , or to administer other gases such as helium , nitric oxide , nitrous oxide , xenon , or certain volatile anesthetic agents such as desflurane , isoflurane , or sevofl... |
Originally made from latex rubber , most modern endotracheal tubes today are constructed of polyvinyl chloride . Tubes constructed of silicone rubber , wire @-@ reinforced silicone rubber or stainless steel are also available for special applications . For human use , tubes range in size from 2 to 10 @.@ 5 mm ( 0 @.@ ... |
In addition to cuffed or uncuffed , preformed endotracheal tubes are also available . The oral and nasal RAE tubes ( named after the inventors Ring , Adair and Elwyn ) are the most widely used of the preformed tubes .
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There are a number of different types of double @-@ lumen endo @-@ bronchial tubes that have endobronchial as well as endotracheal channels ( Carlens , White and Robertshaw tubes ) . These tubes are typically coaxial , with two separate channels and two separate openings . They incorporate an endotracheal lumen which ... |
The " armored " endotracheal tubes are cuffed , wire @-@ reinforced silicone rubber tubes . They are much more flexible than polyvinyl chloride tubes , yet they are difficult to compress or kink . This can make them useful for situations in which the trachea is anticipated to remain intubated for a prolonged duration ... |
= = = Methods to confirm tube placement = = =
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No single method for confirming tracheal tube placement has been shown to be 100 % reliable . Accordingly , the use of multiple methods for confirmation of correct tube placement is now widely considered to be the standard of care . Such methods include direct visualization as the tip of the tube passes through the gl... |
Ideally , at least one of the methods utilized for confirming tracheal tube placement will be a measuring instrument . Waveform capnography has emerged as the gold standard for the confirmation of tube placement within the trachea . Other methods relying on instruments include the use of a colorimetric end @-@ tidal c... |
= = Special situations = =
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= = = Emergencies = = =
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Tracheal intubation in the emergency setting can be difficult with the fiberoptic bronchoscope due to blood , vomit , or secretions in the airway and poor patient cooperation . Because of this , patients with massive facial injury , complete upper airway obstruction , severely diminished ventilation , or profuse upper... |
Personnel experienced in direct laryngoscopy are not always immediately available in certain settings that require emergency tracheal intubation . For this reason , specialized devices have been designed to act as bridges to a definitive airway . Such devices include the laryngeal mask airway , cuffed oropharyngeal ai... |
= = = = Rapid @-@ sequence induction and intubation = = = =
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Rapid sequence induction and intubation ( RSI ) is a particular method of induction of general anesthesia , commonly employed in emergency operations and other situations where patients are assumed to have a " full stomach " . The objective of RSI is to minimize the possibility of regurgitation and pulmonary aspiratio... |
One important difference between RSI and routine tracheal intubation is that the practitioner does not manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing , until the trachea has been intubated and the cuff has been inflated . Another key feature of RSI is the ... |
Since the introduction of RSI , there has been controversy regarding virtually every aspect of this technique , including :
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choice of induction drug , dose and method of administration .
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avoidance of manual ventilation before tracheal intubation .
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optimal position and whether the head @-@ up , head @-@ down , or horizontal supine position is the safest for induction of anesthesia in full @-@ stomach patients .
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application of cricoid pressure ( the Sellick maneuver ) .
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Named for British anesthetist Brian Arthur Sellick ( 1918 – 1996 ) who first described the procedure in 1961 , the goal of cricoid pressure is to minimize the possibility of regurgitation and pulmonary aspiration of gastric contents . Cricoid pressure has been widely used during RSI for nearly fifty years , despite a ... |
Cricoid pressure is often confused with the " BURP " ( Backwards Upwards Rightwards Pressure ) maneuver . While both of these involve digital pressure to the anterior aspect ( front ) of the laryngeal apparatus , the purpose of the latter is to improve the view of the glottis during laryngoscopy and tracheal intubatio... |
RSI may also be used in prehospital emergency situations when a patient is conscious but respiratory failure is imminent ( such as in extreme trauma ) . This procedure is commonly performed by flight paramedics . Flight paramedics often use RSI to intubate before transport because intubation in a moving fixed @-@ wing... |
= = = = Cricothyrotomy = = = =
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A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life @-@ threatening situations , such as airway obstruction by a foreign body , angioedema , or massive facial trauma . A cricothyrotomy is nearly always performed as a last resort in cases wher... |
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