ENDOTRACHEAL TUBES Whilst a tube with a bevelled tip is obviously easier to

pass through the vocal chords, it is more likely to occlude when

the opening makes contact with the tracheal wall. The Murphy
Endotracheal tubes are used to establish and maintain eye provides an alternate gas passage should occlusion occur.
airway patency, prevent aspiration into the lungs, i.e. 'secure' the
airway, and allow mechanical ventilation.

Endotracheal tubes are mostly made of

polyvinylchloride (PVC) and are single-use. They have a
number of characteristic features that are listed below. Many
variations of these designs exist in endotracheal tubes for
particular purposes, as described in the links on the left.

Tube tip design

Endotracheal tubes (ETTs) typically have a left-facing

bevel at the tip and, as a second design feature, a Murphy eye.

The bevel is left-facing rather than right-facing to

allow the ETT tip an easier pass through the vocal chords.
Endotracheal tubes are usually placed with the right hand in a
right-to-left direction towards the larynx (see diagram below).
Cuff design

The majority of endotracheal tubes used in the

operating room are of the low pressure- high volume type.
These cuffs have a comparatively large volume and
consequently large contact area between cuff and trachea. The
cuff can develop folds in this contact area when inflated,
resulting in an increased risk of aspiration secondary to
regurgitated fluid tracking along these fold into the trachea.

In contrast, high pressure-low volume cuffs are

thought to provide better protection against aspiration. Because
of their much smaller cuff-trachea contact area and higher
inflation pressures used, cuff folds are less likely to develop.
The downside of this cuff type is that the higher cuff pressures
are more likely to lead to tracheal mucosal ischemia. The cuff of
the laser tube is of the high pressure- low volume design.
Low pressure- high volume cuff inflated with blue dye inside a
20ml syringe; cuff folds are visible within the large cuff contact
area
High pressure- low volume cuff inflated with blue dye inside a
20ml syringe; no cuff folds are visible within the much smaller
cuff contact area; high pressure- low volume cuff tubes are now
uncommon, we have used a laser tube here to demonstrate this
cuff design
Other features
Polyvinylchloride (PVC), the material which most endotracheal
tubes are made of, does not absorb x-rays. PVC tubes therefore
contain a radio-opaque line, which makes them visible on chest
radiographs.
The radio-opaque line of the ETT is clearly visible on this chest
X-ray.
In addition, most ETTs have a pilot balloon with non-
locking Luer connector and a metal spring valve through which
the cuff can be inflated. The pilot balloon allows visual and
tactile assessment of whether the cuff is inflated or not.
ENDOTRACHEAL INTUBATION
Endotracheal intubation is a medical procedure in
which a tube is placed into the windpipe (trachea) through the
mouth or nose. In most emergency situations, it is placed
through the mouth.
Endotracheal intubation is done to:
Open the airway to give oxygen, medicine, or
anesthesia.
Support breathing in certain illnesses, such as
pneumonia, emphysema, heart failure, collapsed lung
or severe trauma.
Remove blockages from the airway.
Allow the provider to get a better view of the upper
airway.
Protect the lungs in people who are unable to protect
their airway and are at risk for breathing in fluid
(aspiration). This includes people with certain types of
strokes, overdoses, or massive bleeding from the
esophagus or stomach.
Risks include:
Bleeding
Infection
Trauma to the voice box (larynx), thyroid gland, vocal
cords and windpipe (trachea), or esophagus
Puncture or tearing (perforation) of body parts in the
chest cavity, leading to lung collapse
 LIGHT THERAPY
Light therapyor phototherapy, classically referred
to as heliotherapyconsists of exposure to daylight or to
specific wavelengths of light using polychromatic polarised
light, lasers, light-emitting diodes, fluorescent lamps, dichroic
lamps or very bright, full-spectrum light. The light is
administered for a prescribed amount of time and, in some cases,
at a specific time of day. One common use of the term is
associated with the treatment of skin disorders, chiefly psoriasis,
acne vulgaris, eczema and neonatal jaundice.
Light therapy which strikes the retina of the eyes is
used to treat diabetic retinopathy and also circadian rhythm
disorders such as delayed sleep phase disorder and can also be
used to treat seasonal affective disorder, with some support for
its use also with non-seasonal psychiatric disorders
MEDICAL USES
Skin conditions
The treatments involve exposing the skin to ultraviolet
light. The exposures can be to small area of the skin or over the
whole body surface, like in a tanning bed. The most common
treatment is with narrowband UVB (NB-UVB) with a
wavelength of 311313 nanometer. It was found that this is the
safest treatment. Full body phototherapy can be delivered at a
doctor's office or at home using a large high power UVB booth.
Atopic dermatitis
Light therapy is considered one of the best
monotherapy treatments for atopic dermatitis (AD), when
applied to patients who have not responded to traditional topical
treatments. The therapy offers a wide range of options: UVA1
for acute AD, NB-UVB for chronic AD, and
balneophototherapy have proven their efficacy over the recent
past. Patients tolerate the therapy safely but, as in any therapy,
there are adverse effects and care should be taken in its
application, particularly to children.
Psoriasis
For psoriasis, UVB phototherapy has been shown to
be effective. A feature of psoriasis is localized inflammation
mediated by the immune system. Ultraviolet radiation is known
to suppress the immune system and reduce inflammatory
responses. Light therapy for skin conditions like psoriasis
usually use NB-UVB (311 nm wavelength) though it may use
UV-A (315400 nm wavelength) or UV-B (280315 nm
wavelength) light waves. UV-A, combined with psoralen, a drug
taken orally, is known as PUVA treatment. In UVB
phototherapy the exposure time is very short, seconds to minutes
depending on intensity of lamps and the person's skin pigment
and sensitivity. The time is controlled with a timer that turns off
the lamps after the treatment time ends.
Vitiligo
One percent of the population suffer from vitiligo, and
narrowband UVB phototherapy is an effective treatment. "NB-
UVB phototherapy results in satisfactory repigmentation in our
vitiligo patients and should be offered as a treatment option."[6]
Acne vulgaris
High intensity blue light (425nm) used for the treatment of acne.
Evidence for light therapy and lasers in acne vulgaris
as of 2012 is not sufficient to recommend them. There is
moderate evidence for the efficacy of blue and blue-red light
therapies in treating mild acne, but most studies are of low
quality. While light therapy appears to provide short term
benefit, there is a lack of long term outcome data or data in those
with severe acne.
Cancer
According to the American Cancer Society, there is
some evidence that ultraviolet light therapy may be effective in
helping treat certain kinds of skin cancer, and ultraviolet blood
irradiation therapy is established for this application. However,
alternative uses of light for cancer treatment light box therapy
and colored light therapy are not supported by evidence.
Photodynamic therapy (often with red light) is used to treat
certain superficial non-melanoma skin cancers.
Other skin conditions
Phototherapy can be effective in the treatment of
eczema, atopic dermatitis, polymorphous light eruption,
cutaneous T-cell lymphoma and lichen planus. Narrowband
UVB lamps, 311313 nanometer is the most common treatment.
Wound healing
Low level laser therapy has been studied as a potential
treatment for chronic wounds.[15] Reviews of the scientific
literature do not support the widespread use of this technique
due to inconsistent results and low research quality. Higher
power lasers have also been used to close acute wounds as an
alternative to stitching.
Retinal conditions
There is preliminary evidence that light therapy is an
effective treatment for diabetic retinopathy and diabetic macular
oedema.
Mood and sleep related
Seasonal affective disorder
The effectiveness of light therapy for treating SAD
may be linked to the fact that light therapy makes up for lost
sunlight exposure and resets the body's internal clock. Studies
show that light therapy helps reduce the debilitating and
depressive behaviors of SAD, such as excessive sleepiness and
fatigue, with results lasting for at least 1 month. Light therapy is
preferred over antidepressants in the treatment of SAD because
it is a relatively safe and easy therapy.
It is possible that response to light therapy for SAD
could be season dependent. Morning therapy has provided the
best results because light in the early morning aids in regulating
the circadian rhythm.
Non-seasonal depression
Light therapy has also been suggested in the treatment
of non-seasonal depression and other psychiatric mood
disturbances, including major depressive disorder, bipolar
disorder and postpartum depression. A meta-analysis by the
Cochrane Collaboration concluded that "for patients suffering
from non-seasonal depression, light therapy offers modest
though promising antidepressive efficacy."
Neonatal jaundice (Postnatal Jaundice)
A newborn infant undergoing white-light phototherapy
to treat neonatal jaundice.
Light therapy is used to treat cases of neonatal
jaundice through the isomerization of the bilirubin and
consequently transformation into compounds that the newborn
can excrete via urine and stools. A common treatment of
neonatal jaundice is the bili light or billiblanket.
BANDAGE
A bandage is a piece of material used either to
support a medical device such as a dressing or splint, or on its
own to provide support to or to restrict the movement of a part
of the body. When used with a dressing, the dressing is applied
directly on a wound, and a bandage used to hold the dressing in
place. Other bandages are used without dressings, such as elastic
bandages that are used to reduce swelling or provide support to a
sprained ankle. Tight bandages can be used to slow blood flow
to an extremity, such as when a leg or arm is bleeding heavily.
Bandages are available in a wide range of types, from
generic cloth strips to specialized shaped bandages designed for
a specific limb or part of the body. Bandages can often be
improvised as the situation demands, using clothing, blankets or
other material. In American English, the word bandage is often
used to indicate a small gauze dressing attached to an adhesive
bandage.
Types of bandages
Gauze bandage (common gauze roller bandage)
The most common type of bandage is the gauze
bandage, a simple woven strip of material, or a woven strip of
material with a Telfa absorbent barrier to prevent adhering to
wounds. A gauze bandage can come in any number of widths
and lengths, and can be used for almost any bandage application,
including holding a dressing in place.
 Long stretch compression bandages have long stretch
properties, meaning their high compressive power can be easily
adjusted. However, they also have a very high resting pressure
and must be removed at night or if the patient is in a resting
position.

Compression bandage

The term 'compression bandage' describes a wide variety of

bandages with many different applications. Its made up of
elastic.
Triangular bandage

Also known as a cravat bandage, a triangular bandage

is a piece of cloth put into a right-angled triangle, and often
provided with safety pins to secure it in place. It can be used
fully unrolled as a sling, folded as a normal bandage, or for
specialized applications, as on the head. One advantage of this
type of bandage is that it can be makeshift and made from a
fabric scrap or a piece of clothing. The Boy Scouts popularized
use of this bandage in many of their first aid lessons, as a part of
the uniform is a "neckerchief" that can easily be folded to form a
cravat.

These bandages are ideal for use as a sling to support

Short stretch compression bandages are good for protecting an injured limb. They can also be folded and used to secure
wounds on one's hands, especially on one's fingers. splints, and they can also be used for general padding and
protection, such as making a ring pad to protect open wounds
with embedded objects. Because Triangular Bandages are a non-
Short stretch compression bandages are applied to a limb sterile item, care should be taken when using them near open
(usually for treatment of lymphedema or venous ulcers). This wounds.
type of bandage is capable of shortening around the limb after
application and is therefore not exerting ever-increasing pressure
Depending on the nature of the bandage, Triangular Bandages
during inactivity. This dynamic is called resting pressure and is
are either single-use disposable items or they can be reused once
considered safe and comfortable for long-term treatment.
they have been washed and sanitised properly.
Conversely, the stability of the bandage creates a very high
resistance to stretch when pressure is applied through internal
muscle contraction and joint movement. This force is called
working pressure.
Tube bandage frayed or unravelled and these should be discarded safely and
replaced.
A tube bandage is applied using an applicator, and is woven in a
continuous circle. It is used to hold dressings or splints on to
limbs, or to provide support to sprains and strains, so that it
stops bleeding.

Crepe Bandages Plaster of Paris (POP) Bandages

These bandages are typically used to provide light to
medium support soft tissue injuries, compression for joints and
strained muscles, and to apply pressure to bleeding or poisonous
bite sites. They can also be used to secure dressings and protect
open wound injuries.
Crepe Bandages are washable and reusable, but
heavily soiled bandaged are best discarded in an appropriate
disposal unit.
POP bandages consist of a cotton bandage that has been
combined with plaster of paris, which hardens after it has been
made wet. Plaster of Paris is roasted gypsum that has been
ground to a fine powder by milling. When water is added, the
more soluble form of calcium sulfate returns to the relatively
insoluble form, and heat is produced.
These bandages are used to encase a limb (or, in some cases,
large portions of the body) to stabilize and hold anatomical
structures, most often a broken bone (or bones), in place until
healing is confirmed. It is similar in function to a splint.

Once the affected site has healed POP bandages are removed
and discarded they can never be used again.

Conforming Bandages

These bandages are mainly used to secure dressings on

limbs due to their high stretch properties. Because they mould
(conform) to every curve and bump on the body they are ideal
for the retention of dressings. They can also be used for general
light protection of an injured limb or body area.

Conforming bandages are also washable and reusable,

but care should be taken with older bandages that have become

HOSPITAL BED
A hospital bed or hospital cot is a bed specially designed for
hospitalized patients or others in need of some form of health
care. These beds have special features both for the comfort and
well-being of the patient and for the convenience of health care
workers. Common features include adjustable height for the
entire bed, the head, and the feet, adjustable side rails, and
electronic buttons to operate both the bed and other nearby
electronic devices.
Hospital beds and other similar types of beds are used not only
in hospitals, but in other health care facilities and settings, such
as nursing homes, assisted living facilities, outpatient clinics,
and in home health care.
While the term "hospital bed" can refer to the actual bed, the
term "bed" is also used to describe the amount of space in a
health care facility, as the capacity for the number of patients at
the facility is measured in available "beds."
Modern features
Wheels
Wheels enable easy movement of the bed, either
within parts of the facility in which they are located, or within
the room. Sometimes movement of the bed a few inches to a few
feet may be necessary in patient care.
Wheels are lockable. For safety, wheels can be locked
when transferring the patient in or out of the bed.
Elevation
Beds can be raised and lowered at the head, feet, and
their entire height. While on older beds this is done with cranks
usually found at the foot of the bed, on modern beds this feature
is electronic.
Today, while a fully electric bed has many features
that are electronic, a semi-electric bed has two motors, one to
raise the head, and the other to raise the foot.
Raising the head (known as a Fowler's position) can
provide some benefits to the patient, the staff, or both. The
Fowler's position is used for sitting the patient upright for
feeding or certain other activities, or in some patients, can ease
breathing, or may be beneficial to the patient for other reasons.
Raising the feet can help ease movement of the patient
toward the headboard and may also be necessary for certain
conditions.
Raising and lowering the height of the bed can help
bring the bed to a comfortable level for the patient to get in and
out of bed, or for caregivers to work with the patient.
Side rails
Beds have side rails that can be raised or lowered.
These rails, which serve as protection for the patient and
sometimes can make the patient feel more secure, can also
include the buttons used for their operation by staff and patients
to move the bed, call the nurse, or even control the television.
There are a variety of different types of side rails to
serve different purposes. While some are simply to prevent
patient falls, others have equipment that can aid the patient
themself without physically confining the patient to bed.
Side rails, if not built properly, can be of risk for
patient entrapment. In some cases, use of the rails may require a
physician's order (depending on local laws and the policies of
the facility where they are used) as rails may be considered a
form of medical restraint.
Bed exit alarm
Many modern hospital beds are able to feature a bed
exit alarm whereby a pressure pad on or in the mattress arms an
audible alert when a weight such as a patient is placed on it, and
activating the full alarm once this weight is removed. This is
helpful to hospital staff or caregivers monitoring any number of
patients from a distance (such as a nurse's station) as the alarm
will trigger in the event of a patient (especially the elderly or
memory impaired) falling out of the bed or wandering off
unsupervised. This alarm can be emitted solely from the bed
itself or connected to the nurse call bell/light or hospital
phone/paging system.
CPR function
In the event of the bed occupant suddenly requiring
cardiopulmonary resuscitation, some hospital beds offer a CPR
function in the form of a button or lever which when activated
deflates and flattens the bed's air mattress creating a flat hard
surface necessary for effective CPR administration.
Specialist beds
Many specialist hospital beds are also produced in
order to effectively treat different injuries. These include
standing beds, turning beds and legacy beds. These are usually
used to treat back and spinal injuries as well as severe trauma.
Types of Bed
Gatch Bed
The gatch bed has long-standing history of use in
hospitals. They are more often seen in nursing homes and older
and/or remote areas that are economically-challenged that utilize
these beds because of their lack of need for electricity. They
have three cranks at the foot of the bed below the mattress. One
crank raises and lowers the whole bed, one crank raises and
lowers the head of the bed and the last crank raises and lowers
the foot of the bed.
The gatch bed is most often seen in nursing homes.
Electric Bed
The basic modern hospital bed is called an electric bed. They are
the beds most often seen in city hospitals or major town
hospitals. The options of raising and lowering the bed are chosen
through buttons that are set on the side rails. The patients
themselves are able to set the position of their beds as opposed
to the nurses or Certified Nursing Assistants (CNA's) setting the
position manually.
Electric beds are the beds most often seen in city hospitals or
major town hospitals.
Fixed Height Bed
From the name itself, these bed frames have a set stature. Only
the head and foot portion of the bed frame is adjustable. These
are best for patients who really dont mind if the beds height is
too high or low. If they only need a bed that props them up (to
read or watch TV) or raises their legs so they can relax their
spine, the fixed height bed is the best option for them.
Stretchers
The types of beds you see in a hospital emergency
room unit are typically stretchers. These beds are designed for
mobility. In the event a person must dial 911 from a separate
location, these beds can easily transfer from house to ambulance
to the operating room to the ER unit, thanks to special features,
such as folding legs.
The types of beds you see in a hospital emergency room unit are
typically stretchers.
Low Beds
Low beds are specifically designed for those patients
who are liable to fall off beds and cause injury, despite the
restraint of the side rails. Low beds are set from about 8 inches
to less than two feet off the ground at the highest setting. Some
designs of the bed have a high/low maneuvering setting, but
most beds are just low to the ground with just the option to raise
or lower the head and foot of the bed.
 Clinitron Beds

A Clinitron bed is similar to both the low air loss bed

and the circo-electric bed in that it is designed for patients with
pressure ulcers, flaps, grafts, burns or skin disorders. It reduces
pressure on the patients skin because it is filled with material
that resembles sand. Dry, warm air circulates through the
material to maintain a level temperature and to support the
bodys weight evenly.

Low beds are specifically designed for those patients who are
liable to fall off beds and cause injury, despite the restraint of
the side rails.

Low Air Loss Beds

A low air loss bed is a type of bed which has special

cushions and a system designed to blow air into sacs within the
mattress. These beds are designed for burn patients and patients
with skin grafts by keeping them cool and dry, for patients prone
to pressure ulcers and patients with circulatory and/or skin
problems by reducing pressure on the skin.

Legacy Turning Bed

The Legacy Turning bed is the ultimate in severe

A low air loss bed is a type of bed which has special cushions
and a system designed to blow air into sacs within the mattress.
Circo-electric Beds
trauma treatment. Soft padded boards for the head, arms, and
legs can be added to provide support for patients with spinal
injuries. Using electric controls, the bed can be situated into a
number of angles that provide the optimal support for hospital
patients.

A circo-electric bed enables the bed to rotate inside

circular bars that look like a giant hamster treadmill. These beds
used for patients in traction, severe skin conditions, patients who
have severe burns or for patients who spinal injuries that cannot
be moved but must be turned every two hours according to
standard hospital policy.