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The easiest method to perform this technique is the needle cricothyrotomy ( also referred to as a percutaneous dilational cricothyrotomy ) , in which a large @-@ bore ( 12 – 14 gauge ) intravenous catheter is used to puncture the cricothyroid membrane . Oxygen can then be administered through this catheter via jet ins... |
Several manufacturers market prepackaged cricothyrotomy kits , which enable one to use either a wire @-@ guided percutaneous dilational ( Seldinger ) technique , or the classic surgical technique to insert a polyvinylchloride catheter through the cricothyroid membrane . The kits may be stocked in hospital emergency de... |
= = = Tracheotomy = = =
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Tracheotomy consists of making an incision on the front of the neck and opening a direct airway through an incision in the trachea . The resulting opening can serve independently as an airway or as a site for a tracheostomy tube to be inserted ; this tube allows a person to breathe without the use of his nose or mouth... |
= = = Children = = =
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There are significant differences in airway anatomy and respiratory physiology between children and adults , and these are taken into careful consideration before performing tracheal intubation of any pediatric patient . The differences , which are quite significant in infants , gradually disappear as the human body a... |
For infants and young children , orotracheal intubation is easier than the nasotracheal route . Nasotracheal intubation carries a risk of dislodgement of adenoids and nasal bleeding . Despite the greater difficulty , nasotracheal intubation route is preferable to orotracheal intubation in children undergoing intensive... |
Because the airway of a child is narrow , a small amount of glottic or tracheal swelling can produce critical obstruction . Inserting a tube that is too large relative to the diameter of the trachea can cause swelling . Conversely , inserting a tube that is too small can result in inability to achieve effective positi... |
The tip of a correctly positioned tracheal tube will be in the mid @-@ trachea , between the collarbones on an anteroposterior chest radiograph . The correct diameter of the tube is that which results in a small leak at a pressure of about 25 cm ( 10 in ) of water . The appropriate inner diameter for the endotracheal ... |
= = = Newborns = = =
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In newborns free flow oxygen used to be recommended during intubation however as there is no evidence of benefit the 2011 NRP guidelines no longer do .
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= = Predicting difficulty = =
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Tracheal intubation is not a simple procedure and the consequences of failure are grave . Therefore , the patient is carefully evaluated for potential difficulty or complications beforehand . This involves taking the medical history of the patient and performing a physical examination , the results of which can be sco... |
When taking the patient 's medical history , the subject is questioned about any significant signs or symptoms , such as difficulty in speaking or difficulty in breathing . These may suggest obstructing lesions in various locations within the upper airway , larynx , or tracheobronchial tree . A history of previous sur... |
A detailed physical examination of the airway is important , particularly :
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the range of motion of the cervical spine : the subject should be able to tilt the head back and then forward so that the chin touches the chest .
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the range of motion of the jaw ( the temporomandibular joint ) : three of the subject 's fingers should be able to fit between the upper and lower incisors .
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the size and shape of the upper jaw and lower jaw , looking especially for problems such as maxillary hypoplasia ( an underdeveloped upper jaw ) , micrognathia ( an abnormally small jaw ) , or retrognathia ( misalignment of the upper and lower jaw ) .
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the thyromental distance : three of the subject 's fingers should be able to fit between the Adam 's apple and the chin .
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the size and shape of the tongue and palate relative to the size of the mouth .
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the teeth , especially noting the presence of prominent maxillary incisors , any loose or damaged teeth , or crowns .
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Many classification systems have been developed in an effort to predict difficulty of tracheal intubation , including the Cormack @-@ Lehane classification system , the Intubation Difficulty Scale ( IDS ) , and the Mallampati score . The Mallampati score is drawn from the observation that the size of the base of the t... |
= = Complications = =
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Tracheal intubation is generally considered the best method for airway management under a wide variety of circumstances , as it provides the most reliable means of oxygenation and ventilation and the greatest degree of protection against regurgitation and pulmonary aspiration . However , tracheal intubation requires a... |
Four anatomic features must be present for orotracheal intubation to be straightforward : adequate mouth opening ( full range of motion of the temporomandibular joint ) , sufficient pharyngeal space ( determined by examining the back of the mouth ) , sufficient submandibular space ( distance between the thyroid cartil... |
Minor complications are common after laryngoscopy and insertion of an orotracheal tube . These are typically of short duration , such as sore throat , lacerations of the lips or gums or other structures within the upper airway , chipped , fractured or dislodged teeth , and nasal injury . Other complications which are ... |
More serious complications include laryngospasm , perforation of the trachea or esophagus , pulmonary aspiration of gastric contents or other foreign bodies , fracture or dislocation of the cervical spine , temporomandibular joint or arytenoid cartilages , decreased oxygen content , elevated arterial carbon dioxide , ... |
Complications may also be severe and long @-@ lasting or permanent , such as vocal cord damage , esophageal perforation and retropharyngeal abscess , bronchial intubation , or nerve injury . They may even be immediately life @-@ threatening , such as laryngospasm and negative pressure pulmonary edema ( fluid in the lu... |
Inability to secure the airway , with subsequent failure of oxygenation and ventilation is a life @-@ threatening complication which if not immediately corrected leads to decreased oxygen content , brain damage , cardiovascular collapse , and death . When performed improperly , the associated complications ( e.g. , un... |
One complication — unintentional and unrecognized intubation of the esophagus — is both common ( as frequent as 25 % in the hands of inexperienced personnel ) and likely to result in a deleterious or even fatal outcome . In such cases , oxygen is inadvertently administered to the stomach , from where it cannot be take... |
Of 4 @,@ 460 claims in the American Society of Anesthesiologists ( ASA ) Closed Claims Project database , 266 ( approximately 6 % ) were for airway injury . Of these 266 cases , 87 % of the injuries were temporary , 5 % were permanent or disabling , and 8 % resulted in death . Difficult intubation , age older than 60 ... |
= = Alternatives = =
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Although it offers the greatest degree of protection against regurgitation and pulmonary aspiration , tracheal intubation is not the only means to maintain a patent airway . Alternative techniques for airway management and delivery of oxygen , volatile anesthetics or other breathing gases include the laryngeal mask ai... |
General anesthesia is often administered without tracheal intubation in selected cases where the procedure is brief in duration , or procedures where the depth of anesthesia is not sufficient to cause significant compromise in ventilatory function . Even for longer duration or more invasive procedures , a general anes... |
= = History = =
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Tracheotomy
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The earliest known depiction of a tracheotomy is found on two Egyptian tablets dating back to around 3600 BC . The 110 @-@ page Ebers Papyrus , an Egyptian medical papyrus which dates to roughly 1550 BC , also makes reference to the tracheotomy . Tracheotomy was described in the Rigveda , a Sanskrit text of ayurvedic ... |
The first detailed descriptions of tracheal intubation and subsequent artificial respiration of animals were from Andreas Vesalius ( 1514 – 1564 ) of Brussels . In his landmark book published in 1543 , De humani corporis fabrica , he described an experiment in which he passed a reed into the trachea of a dying animal ... |
Despite the many recorded instances of its use since antiquity , it was not until the early 19th century that the tracheotomy finally began to be recognized as a legitimate means of treating severe airway obstruction . In 1852 , French physician Armand Trousseau ( 1801 – 1867 ) presented a series of 169 tracheotomies ... |
In 1871 , the German surgeon Friedrich Trendelenburg ( 1844 – 1924 ) published a paper describing the first successful elective human tracheotomy to be performed for the purpose of administration of general anesthesia . In 1888 , Sir Morell Mackenzie ( 1837 – 1892 ) published a book discussing the indications for trac... |
Laryngoscopy and non @-@ surgical techniques
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In 1854 , a Spanish singing teacher named Manuel García ( 1805 – 1906 ) became the first man to view the functioning glottis in a living human . In 1858 , French pediatrician Eugène Bouchut ( 1818 – 1891 ) developed a new technique for non @-@ surgical orotracheal intubation to bypass laryngeal obstruction resulting f... |
In 1913 , Chevalier Jackson was the first to report a high rate of success for the use of direct laryngoscopy as a means to intubate the trachea . Jackson introduced a new laryngoscope blade that incorporated a component that the operator could slide out to allow room for passage of an endotracheal tube or bronchoscop... |
Between 1945 and 1952 , optical engineers built upon the earlier work of Rudolph Schindler ( 1888 – 1968 ) , developing the first gastrocamera . In 1964 , optical fiber technology was applied to one of these early gastrocameras to produce the first flexible fiberoptic endoscope . Initially used in upper GI endoscopy ,... |
By the mid @-@ 1980s , the flexible fiberoptic bronchoscope had become an indispensable instrument within the pulmonology and anesthesia communities . The digital revolution of the 21st century has brought newer technology to the art and science of tracheal intubation . Several manufacturers have developed video laryn... |
= Maryland Route 704 =
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Maryland Route 704 ( MD 704 ) is a state highway in the U.S. state of Maryland . Known as Martin Luther King Jr . Highway , the highway runs 6 @.@ 53 miles ( 10 @.@ 51 km ) from Eastern Avenue at the District of Columbia boundary in Seat Pleasant east to MD 450 in Lanham . MD 704 is a four- to six @-@ lane divided hig... |
= = Route description = =
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MD 704 begins at an intersection with Eastern Avenue near the eastern corner of the District of Columbia . The highway continues south as 63rd Street , which heads south toward Southern Avenue and East Capitol Street . MD 704 heads northeast as a six @-@ lane divided highway through the city of Seat Pleasant , where t... |
MD 704 is a part of the National Highway System as a principal arterial from US 50 to MD 450 in Lanham .
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= = History = =
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MD 704 follows the abandoned right of way of the defunct WB & A Railway , an interurban railroad that included a north – south line between Washington and Baltimore and a branch to Annapolis from Naval Academy Junction in Odenton . Construction on the electric railway began in 1902 and service began between the three ... |
MD 704 was named for George N. Palmer , a banker and community leader in Seat Pleasant , by 1951 . John Hanson Highway was constructed from US 301 in Bowie west to MD 704 between 1954 and 1957 . MD 704 was expanded to a divided highway through the highway 's interchange with the freeway as part of the construction . I... |
MD 704 was expanded to a divided highway from the District of Columbia boundary to Addison Road in Seat Pleasant in 1962 . The segment of divided highway at the US 50 interchange was extended west to Ardwick Ardmore Road in Glenarden in 1969 . MD 704 's modern cloverleaf interchange with MD 202 was completed in 1971 ,... |
= = Junction list = =
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The entire route is in Prince George 's County .
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= = Auxiliary route = =
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MD 704A was the designation for an unnamed 0 @.@ 15 @-@ mile ( 0 @.@ 24 km ) segment of old alignment of MD 704 at its junction with MD 450 . The designation was assigned in 2000 when MD 704 and MD 450 were relocated . The MD 704A designation and the road itself were removed in 2004 ; the Vista Gardens shopping center... |
= Geet Ramayan =
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Geet Ramayan ( Marathi : गीत रामायण , English : The Ramayana in Songs ) is a collection of 56 Marathi language songs chronologically describing events from the Indian Hindu epic , the Ramayana . It was broadcast by All India Radio , Pune in 1955 – 1956 , four years before television was introduced in India . Written b... |
The team of Madgulkar and Phadke presented a new song every week for a year with every song being aired first on a Friday morning and then again on Saturday and Sunday morning , between 8 : 45 AM and 9 : 00 AM IST . The program 's first song " Kuśa Lava Rāmāyaṇ Gātī " was aired on 1 April 1955 . Though Geet Ramayan is... |
The series showcased a total of 32 various characters from Ramayana . Rama ( avatar of Vishnu and hero of the Ramayana ) being the lead character of the series was given maximum number of songs ( 10 ) , followed by eight songs for Sita ( Rama 's wife and avatar of the Hindu goddess Lakshmi ) . Madgulkar expressed thei... |
With increasing popularity since its release , Geet Ramayan has been translated into nine other languages : five Hindi translations and one each in Bengali , English , Gujarati , Kannada , Konkani , Sanskrit , Sindhi and Telugu . It has also been transliterated into Braille .
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= = Concept = =
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Geet Ramayan was conceptualized in 1955 , four years before the introduction of television in India in 1959 . During the early days of All India Radio , Pune ( also known as Aakashwani Pune ) , station director Sitakant Lad wanted to begin a radio programme which would be entertaining and provide moral education . He ... |
The team of Madgulkar and Phadke would present a new song every week for a year . Every song would be aired first on a Friday morning and then again on Saturday and Sunday morning , between 8 : 45 am and 9 : 00am IST . The programme was initially planned for a year ( with 52 songs ) with the concluding song Trīvār Jay... |
Initially , the programme was scheduled to begin on the occasion of Gudi Padwa , beginning of the New year according to the lunisolar Hindu calendar but later finalized to be Rama Navami , traditional birthday of Rama . The program 's first song " Kuśa Lava Rāmāyaṇ Gātī " was aired on 1 April 1955 at 8 : 45 am IST . V... |
= = Lyrics = =
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