User:Skykryswest/sandbox

ARTICLE EVALUATION


 * Is everything in the article relevant to the article topic? Is there anything that distracted you?
 * All of the information is relevant but a bit disjointed. The article lacks cohesion and a natural flow - I found this distracting.
 * Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?
 * No objectivity issues found.
 * Are there viewpoints that are overrepresented, or underrepresented?
 * I felt the section covering Infraglottic techniques was deficient in its coverage of tracheal intubation with no mention of the various techniques, available tech options or situational factors. Also there is no mention of pediatric qualifiers or extra considerations.
 * Check a few citations. Do the links work? Does the source support the claims in the article?
 * The links checked were functional and consistent with the information provided.
 * Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are these neutral sources? If biased, is that bias noted?
 * Sources are primarily pulled from credible emergency medicine and anesthesia journals or textbooks. There are a few sections without apparent citations attached - this will need to be addressed and information verified.
 * Is any information out of date? Is anything missing that could be added?
 * Tracheal intubation information needs to be updated with proposed addition of subsections to include video vs direct laryngoscopy techniques, nasotracheal intubation and pediatric special considerations. Also considering altering Evaluation section to Confirming Placement, and potentially adding two entirely new sections titled Indications and Outcomes.
 * Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic?
 * There is no debate happening on the Talk page. Issues with this page are more related to deficient information, need for additional sources and better formatting/outline.
 * How does the way Wikipedia discuss this topic differ from the way you would talk about it grand rounds?
 * The most obvious difference is the language used - fewer medical terms and plainer language overall utilized in Wiki article. Grand Rounds typically focuses on a specific patient case or circumstance also vs. this generalized overview of a broad topic.

Nice work, Skyler! It looks like you put a lot of time and thought into this topic. Very critical evaluation of the exisiting article with insightful recommendations for improving it.

Article Lead Edit
Advanced airway management is the subset of airway management that involves advanced training, skill and invasiveness. It encompasses various techniques performed to create an open or patent airway - a clear path between a patient’s lungs and the outside world.

This is accomplished by clearing or preventing obstructions of airways. Obstructions can be caused by many things, including the patient's own tongue, other anatomical components of the airway, foreign bodies, excessive amounts of blood, or aspiration of food particles, liquid or even saliva. Unlike basic airway management such as head-tilt or jaw-thrust maneuver, advanced airway management relies on the use of medical equipment and advanced training. Certain invasive airway management techniques can be performed "blind" or with visualization of the glottis. Visualization of the glottis can be accomplished either directly by using a laryngoscope blade or by utilizing newer video technology options.

In roughly increasing order of invasiveness are the use of supraglottic devices such as oropharyngeal, nasopharyngeal and laryngeal mask airways. Laryngeal mask airways (LMA'S) can even be used to deliver general anesthesia. These are followed by infraglottic techniques, such as tracheal intubation, and finally surgical techniques.

Advanced airway management is a key component in cardiopulmonary resuscitation, anaesthesia, emergency medicine and intensive care medicine.

Indications
There are specific indications or guidelines for deciding a more invasive and more secure airway is worth the associated risk:
 * respiratory failure
 * apnea
 * decreased or altered level of consciousness, rapid mental status change, Glasgow Coma Scale score less than 8 (GCS<8).
 * major trauma, such as penetrating injury to abdomen or chest
 * direct airway injury or facial burns
 * high risk of aspiration

Tracheal intubation
Tracheal intubation, often simply referred to as intubation, is the placement of a flexible plastic or rubber 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 facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction. 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.

Alternatives to standard endotracheal tubes includes laryngeal tube and combitube.

Confirming Placement
The absolute gold standard for confirming successful placement of an endotracheal tube is direct visualization of the tube passing through the vocal cords. Other methods used as secondary confirmation include carbon dioxide detectors, capnography, oxygen saturation, equal chest rise and equal breath sounds heard on both sides of the chest, or post intubation chest x-ray.

Pediatric Considerations
It is always important not to think of children as just small adults. They are unique in far more ways than simply being smaller in size. There are many basic differences in anatomy compared to adults that can effect airway management. For example children's heads are proportionally larger in relation to their overall body size. This can cause alignment issues that have the potential to make it substantially more difficult to obtain good visualization of the appropriate airway landmarks. The differences in a child's anatomy can also effect equipment choices, such as choosing a straight laryngoscope blade instead of a curved one. Making the right equipment choices is so important that a color-coded tape measure called the Broselow tape was created to help facilitate rapid and accurate decisions in pediatric emergency situations. Birth complications, congenital syndromes, such as Down syndrome, and even recent illness or nasal congestion can effect how airway management is approached in a child.

When ventilation, various airway options and even intubation are unsuccessful, this is a terrifying situation known as "cannot ventilate, cannot intubate". Typically this is when a cricothyrotomy would be attempted as mentioned above in Surgical techniques. However, this tricky procedure is even more difficult in kids due to their extra flexible airways. The chance of accidentally puncturing all the way through the trachea to the esophagus increases substantially. The risk is considered so high that the procedure is contraindicated in children under the age of 5-6 years old.