面罩给氧及气管插管 .ppt

Airway Management * Most male patients require the endotracheal tube to be tied at about 23 cm from the tip. Most female patients require the endotracheal tube to be tied at about 21 cm from the tip. Tip Auscultation of breath sounds over the chest and epigastrium may be useful to detect a tube that is too deep and in a main bronchus. Most commonly decreased breath sounds on the left side are heard, indicating a right main bronchus intubation. * Once obstruction has been resolved it may be possible to allow the patient to breathe spontaneously (the left lateral position is recommended). Usually some form of ventilatory assistance is required. In this setting a manual bag valve resuscitator is usually used. Requires time and experience to master technique - skill station. Most resuscitators are self-inflating with a separate reservoir bag in series that ensures a consistent oxygen concentration. Note valve arrangement - must know how the valves work (skill station) and test to make sure the assembly works before use. Wall flow must be adequate to keep reservoir bag inflated (usually 15l/min). Self inflating part and reservoir. The addition of positive end-expiratory pressure (PEEP) valves may improve arterial oxygenation and help to overcome airway obstruction due to laryngospasm. Transparent masks are recommended. * Tips and pitfalls Gastric insufflation is common and increases the risk of vomiting and aspiration. Severe intra-abdominal distension may cause cardiovascular compromise. Carefully applied cricoid pressure may prevent gastric gas insufflation. Over-distention of the lungs. Tidal volumes of 1.5-2L can be delivered. Rapid delivery of high tidal volumes can easily lead to gas being retained in the lung. Over distention and high intra-thoracic pressures may cause profound haemodynamic instability. Tips Concentrate on providing tidal volumes of only about 300-500ml at respiratory rates of 10-16/min. In the emergency situation with a full