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3 results

  • 2.8 - Imaging of the Chest

  • from Section 2 - Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 47-60

  • Summary

    Key Learning Points

    1. 1. Chest X-ray anteroposterior (AP) films magnify the heart and mediastinum, and obscure the left lower zone.

    2. 2. When assessing the correct positioning of internal jugular central venous catheter placement, as a rule of thumb, the tip should lie at the level of the carina and to the right of the mediastinum.

    3. 3. When assessing the correct positioning of an endotracheal tube, the tip should lie 5–7 cm above the carina.

    4. 4. When assessing the lung fields, divide the lungs into three zones: upper, middle and lower thirds. Compare each side and check for asymmetry.

    5. 5. Consolidation refers to small airways and alveoli that are filled with material – pus, fluid, blood or cells. Consolidation is not synonymous with infection.

  • 5.4.3 - Nasogastric Tube Placement and Position Confirmation

  • from Section 5.4 - Practical Gastrointestinal System
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 617-619

  • Summary

    Key Learning Points

    1. 1. There are different types of tubes for different indications.

    2. 2. For ease of insertion, keep the tubes in the fridge, ensure good lubrication and optimise head positioning.

    3. 3. Use the pH of the aspirate, and/or a chest radiograph, to check positioning.

    4. 4. On a chest radiograph, a correctly sited nasogastric tube should pass down the midline and bisect the carina, before passing below the diaphragm.

    5. 5. If initiating nasogastric feeding, start thinking about long-term feeding plans early, as in practice, these can take a while to sort out.

  • Chapter 29 - Anesthesia for otologic and neurotologic surgery

  • from Section 4 - Anesthesia for laryngotracheal surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 271-296

  • Summary

    The location of Zenker's diverticulum along with the inherent risks of aspiration at any given stage of surgery (pre-, intra- or postoperative periods) adds an element of unique difficulty in the anesthetic approach to these patients. This chapter explores the anesthetic considerations for this unique procedure. The surgical procedure is generally curative and a majority of the patients live symptom-free for the rest of their lifetime. A main concern during the induction period is to safely secure the airway without increasing the risk of aspiration. While regurgitation and aspiration may occur during induction of anesthesia and during intubation, they might still happen even after successful uneventful intubation. Pertinent perioperative evaluation should include detailed cardiovascular and nutritional status evaluation and optimization. Perforation of Zenker's diverticulum may occur during a difficult intubation, or during blind placement of a nasogastric tube.