气管插管课件.pptVIP

* Figure 42-14 Four types of commonly available endotracheal tubes. The cuffs are inflated with 10 mL of air. A, Microlaryngoscopy (MLT) tube (Mallinckrodt Co., St. Louis, MO) and extra-long, small-caliber (6.0-mm) polyvinyl chloride tube useful for laryngeal surgery. B, Standard intermediate pressure cuff and polyvinyl chloride tube (Mallinckrodt Co.). C, Armored anode tube with built-in spiral wire to minimize the opportunity of collapse or kinking. D, Flex-tip tube (Parker Medical, Englewood, CO) to facilitate insertion over a stylet or bougie. The numbers and letters visible on the tubes denote tube diameter, length from the tracheal end, and confirmation that the tubes have been tested for tissue compatibility (IT or Z-79). * * * * * * Figure 42-16 Examples of the most frequently used detachable laryngoscope blades, which can be used interchangeably on the same handle. The upper blade is the straight or Jackson-Wisconsin design. The middle blade incorporates a curved distal tip (Miller). The lower blade is the curved or MacIntosh blade. All three blades are available in lengths appropriate for neonates and adults. * * * * * * McCoy 喉镜的尖端设计成可活动型，更容易挑起会厌和方便插管。 * * * * * * 必要时，可用管芯将气管导管重塑成“曲棍球球棒”的形状，使其易于进入上咽喉部。 还应准备好吸痰器以备用。开放静脉通道，若时间和病情允许时，最好接好监护仪。插管时，让助手观察监视仪并及时汇报病情变化。 调整病床的高度以使病人的头位相当于操作者的剑突水平。 * * * * * * Robert 比较了正常婴儿和成人在呼吸空气后呼吸暂停和肺泡内贮备氧耗尽的时间效应。 正常病人呼吸暂停后贮备氧耗尽的时间，在婴儿约36秒，而成人约84秒几乎是婴儿的两倍。 * * * * * * 依托咪酯是目前所有诱导药中血流动力学最稳定的，很少引起呼吸和心肌抑制,还可降低颅内压,在所有诱导药中最安全。故休克、心肺功能不全、急性心肌缺血和头部创伤者需快诱导插管时，依托咪酯不失为一种好的选择。 司可林是目前唯一的真正速效、超短效的肌松药，应用于急诊饱胃者的气管插管已有四十余年的历史。司可林相关的高钾血症通常是在给药后2-7 d 后出现,且有赖于创伤或原发病。急诊情况下，除外已知高血钾、有显著高钾风险者(大面积烧伤、挤压伤、去神经支配和神经肌肉病等)或ECG提示高钾者，司可林仍是首选。 * * * * * * Figure 42-17 A volunteer positioned on the Popitz sniffing position pillow (DermaCare, Louisville, KY) demonstrates cervical flexion and a small degree of atlanto-occipital extension. The flexion aligns the laryngeal and pharyngeal axes. Further extension of the head results in the true sniffing position