呼吸窘迫的處理

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誉儡阳
5 years ago
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1 理

2 Case 1, 狀 1

4 Airway : oral or nasal Nasal cannula Mask Non-rebreathing Mask (NRM) 10-15L/min

7 Oropharyngeal Airways Aid in preventing the tongue from occluding the airway. Incorrect insertion can displace the tongue into the hypopharynx, causing airway obstruction. Use in unconscious (unresponsive) patient with no cough or gag reflex. Should be inserted only by trained persons (Class IIa, LOE C).

10 Nasopharyngeal Airways Useful in patients with airway obstruction or at risk for developing airway obstruction. Clenched jaw. Better tolerate than oral airways in patients who are not deeply unconscious. Complication Airway bleeding. Requires adequate training, practice, and retraining. Contraindication known or suspected basal skull fracture or severe coagulopathy (Class IIa, LOE C).

11 Oxygen Cannula

12 Simple Mask

13 Non Rebreathing Mask

14 Bag Mask Ventilation (BVM)

15 BVM (Bag-Valve-Mask) 易理. 30L/min 流. 不塞.., 不 ( during CPR). 量 10ml/kg( ) 6-7ml/kg( ). 1,,.

16 Complication of BVM Regurgitation. Aspiration. Pneumonia. Gastric inflation Can elevate diaphragm Restrict lung movement Decrease lung compliance.

17 Supraglottic Airways Laryngeal mask airway (LMA) Esophageal-tracheal Combitube (ETC) Laryngeal tube (LT)

18 Laryngeal Mask Airway (LMA) Does not require laryngoscopy and visualization of the vocal cords. Simple than endotracheal intubation. Use in unstable neck injury or appropriate positioning of the patient for endotracheal intubation is impossible. An acceptable alternative to bag mask ventilation or endotracheal intubation for airway management in cardiac arrest.

19 LMA: laryngeal mask airway

21 LMA (Laryngeal Mask Airway)

22 Esophageal-tracheal tube (Combitube) 1. Ease of training 2. Isolation of the airway 3. Reduce risk of aspiration 4. More reliable ventilation Fatal complications may occur if the position of the distal lumen of the esophageal-tracheal tube in the esophagus or trachea is identified incorrectly. Other possible complications esophageal trauma, lacerations, bruising and subcutaneous emphysema.

23 Esophageal trachea combitube(etc)

24 Laryngeal tube (Laryngeal Tube or King LT) Similar to ETC More compact and less complicated to insert. As an alternative to bag-mask ventilation (Class IIb, LOE C) or endotracheal intubation for airway management in cardiac arrest (Class IIb, LOE C).

25 Laryngeal tube

26 力

27 Case 1, 狀 2? BVM? 立??? On ECG monitor, asystole CPR 30.

28 Case 1, 狀 2 理不? 1. 2.? 3. monitor?

29 Endotracheal Intubation Unskill can produce complications, such as trauma to the oropharynx, interruption of compressions and ventilations, hypoxemia from prolonged intubation tube misplacement or displacement. Vary based on provider experience. Frequent retraining is recommended for providers who perform endotracheal intubation (Class I,LOE B)

30 Case 1, 狀 2, 1? ABG 料? (RR>35/min),ABG: ph:7.50 PaO2:98, PaCO2:25, HCO3:22, SaO2:98%,?

31 Case 1, 狀 2, 1 不, coma 力不不 Don t intubate to death No death to intubate?

32 Case 1, 狀 2, 2 BVM? SpO2 都 96%? BVM bagging?

33 Case 2, 狀 1 :, BVM, Bagging,, 不 vocal cord 狀, 不見?

35 Case 2, 1 Sellick Maneuver? Sellick Maneuver? 不 vocal cord, Sellick Maneuver,?,?,?

36 Cricoid Pressure Use in non arrest patients. May also impede ventilation and interfere intubation. So, routine use of cricoid pressure in cardiac arrest is not recommended. (class III, LOE C)

42 Assessment to ensure that it is properly position Physical examination 1. Visualizing chest expansion bilaterally. 2. Listening over the epigastrium (breath sounds should not be heard) 3. The lung fields bilaterally (breath sounds should be equal and adequate). A device used to confirm correct placement to reduce risk of unrecognize tube misplacement and displacement Continuous waveform capnography (Class I, LOE A), exhaled CO2 detectors.

43 Capnography

44 Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases. Capnography provides an immediate, Pulse oximetry is delayed. Hold your breath. Capnography will show immediate apnea, while pulse oximetry will show a high saturation for several minutes.

45 Capnography Carbon dioxide in a patient s exhaled breath. Evaluate a patient s ventilatory status. ETCO mm Hg is the normal value. ETCO2<35 mmhg(hyperventilation/hypocapnia) ETC02>45 mmhg(hypoventilation/hypercapnia)

46 ETCO2 is zero: The tube is in the esophagus.

49 Esophageal Detector Device (EDD)

50 Oesophageal detector devices (ODD) Design to aspirate air via the endotracheal tube. The ability to aspirate air easily when connected to an ETT indicates tracheal intubation (the trachea and main bronchi have a rigid structure and do not collapse when a negative pressure is applied). Failure to aspirate air indicates oesophageal intubation (the oesophagus collapses around the end of the ETT).

51 Postintubation Airway Management Record the depth of the tube as marked at the front teeth or gums and secure it. Continuous monitoring of endotracheal tube with waveform capnography. Should be secured with tape or a commercial device (Class I, LOE C). Devices and tape should be applied in a manner that avoids compression of the front and sides of the neck, which may impair venous return from the brain.

52 Case 2, 2? 不? RSI,?

53 Case 2, 2, 神刺, IICP 易不

54 RSI: Rapid Sequence Intubation :

55 不 RSI 不, 切? BVM 良 SpO2

56 LOAD Atropine : 0.02mg/Kg Lidocaine: 1.5mg/kg, IICP, Head injury : Midazolam mg/kg(<5mg) Diazepam mg/kg(<10mg) Thiopental 3-5mg/kg : Vecuronium 0.01mg/kg Succinlycholine 1.5mg/kg

57 Atropine 0.02mg/kg IV Lidocaine 1.5mg/kg IV over 60 sec Midazolam mg/kg IV slowly Valium 5-10mg iv push slowly Propofol 2-2.5mg/kg IV Ketamine 1-4.5mg/kg IVP 60sec (50mg/amp)

58 Case 3 Demeral 50mg, Valium 10mg RR 6/min RSI??

59 Case 3 BVM bagging Anexate naloxone

急診暨總夜班護理業務觀摩簡介

急診暨總夜班護理業務觀摩簡介呼吸道處置蘇柏樺課程大綱打開呼吸道輔助物使用氣管插管快速插管 (RSI) 氧氣使用呼吸問題 ( 評估三部曲 ) 呼吸道呼吸動力氧氣需求評估呼吸道是否通暢說話清楚? 聲音嘶啞? 無法回應? 已放置的氣管內管, 功能是否正常? Axis of