气道通气的识别和评估（英文）课件

1、Assessment & Recognition of Airway & Ventilatory CompromiseHistoryOnsetsudden vs gradualKnown cause?DurationConstantRecurrentProvocation/PalliationAssessment & Recognition of Airway & Ventilatory CompromiseExacerbationAssociated Signs/SymptomsCough, chest pain, feverInterventionspast evals/admitsmed

2、sever intubated before?Assessment & Recognition of Airway & Ventilatory CompromiseRespiratory PatternsCheyne-Stokesbrain stemKussmaulacidosisBiotsincreased ICPRespiratory PatternsCentral Neurogenic Hyperventilationincreased ICPAgonalbrain anoxiaAssessment & Recognition of Airway & Ventilatory Compro

3、miseInadequate Ventilationbody cannot compensate for increased oxygen demand or maintain balanceCausesinfectiontraumabrainstem injurytoxic inhalationrenal failureAirway & Ventilation Methods: BLSSupplemental Oxygenincreased FiO2 increases available oxygenobjective is to maximize hemoglobin saturatio

4、nAirway & Ventilation Methods: BLSOxygen sourcecompressed gasliquid oxygenRegulatorsHumidifierDelivery Devicesnasal cannulapartial rebreather masknon-rebreather maskventuri masksmall volume nebulizerAirway & Ventilation Methods: BLSAirway ManeuversHead-tilt/Chin-liftJaw thrustSellicks maneuverOther

5、Typestracheostomy with tubetracheostomy with stomaAirway DevicesOropharyngeal airwayNasopharyngeal airwayAirway & Ventilation Methods: BLSFlow-restricted, powered ventilatorCardiac sphincter opens at 30 cm H2Ohigh volume/high concnot recommended for children, noncompliant or poor tidal volumeoxygen

6、delivered on inspiratory effortmay cause barotraumaAirway & Ventilation Methods: BLSAutomatic transport ventilatorsNot like a “real” ventilator Usually only controls Volume and rateUseful during prolonged ventilation timesNot useful in obstructed airway or increased airway resistanceFrees personnelC

7、an not detect changes Airway & Ventilation Methods: BLSPediatric considerationsmask seal force may obstruct airwaybest if used with jaw thrustBVM sizes: neonate & infant=450 ml +Children 8 yoa require adult BVMjust enough volume to see chest riseSqueeze - Release - ReleaseAirway & Ventilation Method

8、s: BLSGastric DistentionCommon when ventilating without intubationpressure on diaphragmresistance to BVM ventilationincrease time of BVM ventilationAirway Management: Part 2EMS ProfessionsTemple CollegeAirway & Ventilation Methods: ALSGastric Tubesnasogastric caution with esophageal disease or facia

9、l traumatolerated by awake patients but is uncomfortablepatient can speakinterferes with BVM sealorogastricusually used in unresponsive patientslarger tube may be usedsafe in facial traumaAirway & Ventilation Methods: ALSNasogastric Tube InsertionSelect size (french)Measure length nose to ear to xip

10、hoidLubricate end of tubewater solubleMaintain aseptic techniquePosition patient sitting up if possibleAirway & Ventilation Methods: ALSOrogastric Tube InsertionSelect size (french)Measure lengthLubricate end of tubeMaintain aseptic techniquePosition patient (usually supine)Insert into mouthAdvance

11、gradually but steadilyAirway & Ventilation Methods: ALSOrogastric Tube Insertion (cont)Assess placement & secureinstill air or aspirateEvacuate contents as neededAirway & Ventilation Methods: ALSEndotracheal IntubationTube into the trachea to provide ventilations using BVM or ventilatorSized based u

12、pon inside diameter in mmLengths increase with increased IDcm markings along lengthCuffed vs UncuffedAirway & Ventilation Methods: ALSEndotracheal IntubationIndicationspresent or impending respiratory failureapneaunable to protect own airwayAdvantagessecures airwayroute for a few medicationsoptimize

13、s ventilation and oxygenationAirway & Ventilation Methods: ALSThese are NOT IndicationsBecause I can intubateBecause they are unresponsiveBecause I cant show up at the hospital without itAirway & Ventilation Methods: ALSComplications of endotracheal intubationBleeding or dental injuryLaryngeal edema

14、LaryngospasmVocal cord injuryBarotraumaHypoxiaAspirationDislodged tube or esophageal intubationRight or Left mainstem intubationAirway & Ventilation Methods: ALSTechniques of InsertionOrotracheal Intubation by direct laryngoscopyBlind Nasotracheal IntubationDigital IntubationRetrograde IntubationTra

15、nsillumination techniquesAirway & Ventilation Methods: ALSOrotracheal Intubation by direct laryngoscopyPosition & Ventilate patientMonitor patientECGPulse oximeterAssess patients airway for difficultyAssemble & check equipment (suction)Hyperventilate patient (30-120 sec)Airway & Ventilation Methods:

16、 ALSOrotracheal Intubation by direct laryngoscopy (cont)Position patientOpen mouth & insert laryngoscope bladeAttempt to sweep tongue (straight blade)Identify anatomical landmarksAdvance laryngoscope bladeVallecula for curved (Miller) bladeUnder epiglottis for straight (Miller) bladeAirway & Ventila

17、tion Methods: ALSOrotracheal Intubation by direct laryngoscopy (cont)Elevate epiglottisDirectly with straight (miller) bladeIndirectly with curved (macintosh) bladeVisualize the vocal cords & glottic openingEnter the mouth with the tube from corner of mouthAirway & Ventilation Methods: ALSOrotrachea

18、l Intubation by direct laryngoscopy (cont)Advance into glottic opening approx. 1/2 inch past vocal cordsContinue to hold tube & note locationInflate cuff until firm (approx 10 cc)Ventilate & Auscultateepigastriumleft and right chestAirway & Ventilation Methods: ALSOrotracheal Intubation by direct laryngoscopy (cont)Secure tubeReassess Ventilation Effectivenessauscultationclinical signsend-tidal CO2Esophageal detection device Airway & Ventilation Methods: ALSEquipmentLaryngoscope Handle (lighted) & BladesStyletSyringeMagillsLubricantSuctionBVMBAAM (BNI)SelectionTypical Adult