呼吸道通气方法ALS3课件.ppt

Airway Ventilation Methods: ALS Curved (Macintosh) Blade Visualize anatomy Insert from right to left Lift upward and away Blade in vallecula Lift epiglottis indirectly Airway Ventilation Methods: ALS Straight (Miller) Blade Visualize anatomy Insert from right to left moving tongue away Lift upward and away Blade past vallecula and over epiglottis Lift epiglottis directly Tube Positioning Airway Ventilation Methods: ALS Blind Nasotracheal Intubation Position Oxygenate patient Monitor patient ECG Monitor Pulse oximeter Assess for BNI difficulty or contraindication Assemble check equipment Lubricate end of tube; Do not warm Attach BAAM (if available) Airway Ventilation Methods: ALS Blind Nasotracheal Intubation (cont) Position patient (preferably sitting upright) Insert tube into largest nare Advance slowly but steadily Listen for sound of whistle via BAAM Advance tube Inflate cuff Assess placement Secure Reassess Airway Ventilation Methods: ALS Digital Intubation Blind technique Variable probability of success Using middle fingers to locate epiglottis Lift epiglottis Slide lubricated tube along side fingers Assess tube placement depth as with orotracheal intubation Airway Ventilation Methods: ALS Airway Ventilation Methods: ALS Surgical Cricothyrotomy Indications absolute need for a definitive airway AND unable to perform ETT due for structural or anatomic reasons, AND risk of not intubating is than surgical airway risk OR absolute need for a definitive airway AND unable to clear an upper airway obstruction, AND multiple unsuccessful attempts at ETT, AND other methods of ventilation do not allow for effective ventilation and respiration Airway Ventilation Methods: ALS Surgical Cricothyrotomy Contraindications (relative) No real demonstrated indication Risks benefits Age 8 years (some say 10) evidence of fx larynx or cricoid cartilage evidence of tracheal transection Airway Ventilation Methods: ALS Surgical Cricothyrotomy Tips Know your anatomy Shor