Rarely, airway edema prevents endotracheal intubation and a surgical airway (e.g., emergency tracheostomy) is needed. Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema. There is no additional code for the use of sedation, which may be documented as RSI (rapid sequence induction), or for use of a scope (e.g., Glide scope) for assistance in the placement of the endotracheal tube. However, intubation, there is little to be lost by an initial look in an awake and breathing patient with a conventional laryngoscope and a local anesthetic spray. In conclusion, infants who were born at 25-to-28-weeks' gestation and were breathing spontaneously were treated with CPAP shortly after birth. Our study does not help to identify infants at birth who if treated with CPAP will subsequently require intubation and ventilation. Many patients who receive dissociative-dose ketamine without a paralytic will have some muscle rigidity, and some will develop laryngospasm (which is glottic muscle rigidity). According to the Brazilian Journal of Anesthesiology study, 2014, video laryngoscopy with C-MAC (Karl Storz) improves the glottic view and increases the success rate of tracheal intubation in cases of difficult intubations with conventional direct laryngoscopes.
Orotracheal intubation triggers minimal pain and is an easy-to-perform process under direct laryngoscopy. If the pneumothoraxes were associated with the CPAP pressure, it is curious that the incidence was lower in the intubation group, which had higher peak and mean airway pressures. Since antenatal consent had to be obtained, there was a lower incidence of acute or serious antenatal complications, and most mothers received antenatal corticosteroids. Although the exact benefit of corticosteroids has not been established, most experts advocate their administration. If an intravenous line cannot be established, the intramuscular dose can be injected into the posterior one third of the sublingual area, or the intravenous dose may be injected into an endotracheal tube. Steroid medicines given by mouth will usually be continued for several days after discharge, and albuterol can be given as needed, usually up to a frequency of a dose every four hours. The dose may be repeated two or three times at 10 to 15 minutes intervals. It should be released every five minutes for at least three minutes, and the total duration of tourniquet application should not exceed 30 minutes. The tourniquet pressure should ideally occlude venous return without compromising arterial flow.
To slow absorption of injected antigens (e.g., insect stings), a tourniquet may be placed proximal to the injection site. The site may be gently massaged to facilitate absorption. Alternatively, 0.15 to 0.3 mL of 1:1,000 aqueous epinephrine (0.1 to 0.2 mL in children) may be injected into the site. If the antigen was injected (e.g., insect sting), the portal of entry may be noted. Epinephrine 1:1,000 dilution, 0.2 to 0.5 mL (0.2 to 0.5 mg) in adults, or 0.01 mg per kg in children, should be injected subcutaneously or intramuscularly, usually into the upper arm. The following regimen is reasonable: 1:10,000 (100 mcg per mL) epinephrine at 1 mcg per minute, increased to 10 mcg per minute as needed. While volume replacement is central to management of hypotension in anaphylaxis, other pressors such as dopamine (Intropin), 2 to 20 mcg per kg per minute, may be required. Excerpted from: Management of unanticipated difficult intubation.