科室-机械通气-2015-11解释.ppt

人工气道湿化的方法 加热湿化器 雾化吸入 气道内滴药 人工鼻 加热湿化器使用要求: 温度设置：32-37 相对湿度：95%-100% 湿化液：无菌蒸馏水或无菌注射用水 湿化量：24h不少于250ml 使用加热湿化器的监测事项： 监测温度：吸入气体温度不超过40.c 监测湿化液量： 湿化液维持在湿化罐标刻线处 湿化罐内要及时加水。 雾化吸入注意事项 雾化器安装在呼吸机送气管路 无菌操作 剩余雾化液及时处理 气道内滴入： 常用气道内间断滴注和持续给药法 一般根据病人痰液粘稠度适时滴入 每次滴入的量3-5ml 滴入湿化液：0.9%NS、0.45%NS、2%NaHCO3 气道内滴入操作注意事项： 吸气相时滴入药液 滴入药液时要沿气管导管壁滴入 滴入速度不要过快 人工气道湿化的标准 分泌物 吸引管 病人 湿化满意 稀薄 顺利通过 安静 呼吸道通畅 湿化不足 粘稠 吸引困难 呼吸困难 紫绀加重 湿化过度 过分稀薄 频繁吸引 痰鸣音多 紫绀加重 * * The head tilt, jaw thrust, mouth open (triple airway maneuver) is used when other methods have failed to open the airway. The head is tilted back in extension and the fingers of both hands grasp the ramus of the mandible which is displaced forward and upward. Both thumbs are then used to open the lower lips. BEWARE OF PATIENTS WITH CERVICAL SPINE INJURIES - SEE TRAUMA LECTURE * * Airway management can be divided into BASIC AND ADVANCED MANAGEMENT Basic airway maneuvers Relieving obstruction by the head tilt is easy and effective. A hand firmly placed on the forehead tilts the head backward on the atlanto-occipital joint The chin lift is completed by placing the fingers of the one hand under the bony part of the lower jaw and lifting the chin forward. Note The tongue and posterior pharynx is lifted away from the posterior pharynx * * Oropharyngeal airways may be useful to prevent soft tissues from obstructing the airway in the unconscious patient at the levels of the soft palate, epiglottis and base of tongue. An oropharyngeal airway may establish an adequate airway for spontaneous or bag-mask ventilation when proper head positioning is insufficient. It is inserted with the concavity facing the palate and then rotated 1800 into the proper position as it is advanced. Additional points Complications Gagging\, laryngospasm, or vomiting. Mucosal trauma, worsening the obstruction by pressing the epiglottis against the laryngeal outlet or displacing the tongue more posteriorly. * * Inadequate ventilation: The