医、技学院华盛顿医疗手册培训(急诊医学1)概要1.pptVIP

Bill Busse Department of Emergency Medicine, ?SAHZU Medical Emergencies 1. Airway emergencies √ Acute upper airway obstruction Pneumothorax Near-drowning Acute upper airway obstruction 1. General principals 1.1Etiology . In awake patients - a foreign body, angioedema . In unconscious patients – tongue, foreign body, trauma, infection, angioedema 2. Diagnosis 2.1 Clinical presentation 2.1.1 History – commonly unavailable 2.1.2 Physical examination Conscious patient: stridor,impaired phonation,sternal or suprasternal retraction,choking sign, repiratory distress Unconscious patient: labored breathing, apnea,difficult ventilation - All patient look for urticaria, angioedema, fever, and evidence of trauma - partial obstruction in the awake patient with adequate ventilation: looking for airway swelling, trismus, pharyngeal obstruction, respiratory retractions, stridor,neck mass.... - airway obstruction in an unconscious patient without intact ventilation: examine the upper airway visually for evidence of obstruction. 2.2 Differential diagnosis -trauma to the face and neck, foreign body, infection, tumor, angioedema, laryngospasm …. 2.3 Diagnostic testing 2.3.1 Imaging: partial obstruction in the awake patient with adequate ventilation: - Radiography of the neck (PA,L view): perofrmed in ER - rapid CT: 2.4 Diagnostic procedures partial obstruction in the awake patient with adequate ventilation: - indirect laryngoscopy - fiberoptic nasopharyngolaryngoscopy 3. Treatment: prevent CA 3.1 Nonsurgical management 3.1.1 Awake patient without ventilation: - Heimlich maneuver - a second technique (back slaps, chest thrusts) 3.1.2 Unconscious patient without ventilation: - head tilt-chin lift maneuver or a jaw thrust - oral or nasal airway - ventilate BVM - laryngoscope to remove FB - the supine Heimli