人工气道建立课件.pptVIP

人工气道建立 气管插管前的准备工作 Talk to the patient Explain! Clearly! CALL FOR HELP EARLY! 维持气道的基本手法 维持气道的基本方法 – 鼻咽通气道 手法通气 手法通气 气管插管前的准备工作 镇静药与肌松药 仅在必要时使用 必须能够维持气道 注意suxamethonium的副作用, 可以使用rocuronium, 但作用时间较长 喉镜 直接喉镜下可见的解剖结构 气管插管 气管插管 气管插管技术 气管插管技术 气管插管技术 气管插管技术 气管插管 气管插管 确认气管插管位置 确认气管插管位置 气管插管的位置 快速插管步骤 预氧合 环状软骨加压 按照预先确定的剂量推注药物 立即插管 确认插管位置后放松对环状软骨的压迫 环状软骨加压 气管插管失败 气管插管失败率约1 – 5% 缺氧的后果可能致命 困难气道 short neck, obese or muscular (thyro-mental distance 6 cm) limited neck and jaw movements protruding teeth, small mouth, long high curved palate, or receding lower jaw obstructing lesions in the oropharynx and larynx No anticipated intubation difficulty Rapid sequence induction Direct laryngoscopy and intubation Call for help Reposition patient. One more D.L. attempt Confirm tube position ventilate patient Maintain ventilation wake up patient or advanced airway techniques* Surgical Airway Insert laryngeal mask Ventilation Fail No No Yes Succeed Fail * If experienced help available Yes Able to manually ventilate Succeed Anticipated difficulty Call for help Planning preparation for intubation Maintain spontaneous or assisted breathing Wait for Help Obstruction or impending arrest Go to figure 4 In awake patients, explanation of what you are about to do is essential to relieve anxiety. If you lack experience and there is any possibility of summoning experienced help then help should be summoned immediately. Any kind of help is useful if you run into difficulty during intubation. IT CANNOT BE OVERSTRESSED - DO NOT HESITATE TO CALL FOR HELP IF YOU THINK IT MAY BE NECESSARY. 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