國(guó)際創(chuàng)傷生命支持ITLS-03-氣道處理Chapter4_Airway_SC

1、Campbell, International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Al

2、abama Chapter, American College of Emergency Physicians Chapter 4 Initial Airway Management Campbell, International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Initial Airway Management 氣道處理氣道處理 Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Ed

3、ucation, Inc., Upper Saddle River, NJ Overview概欖概欖 Respiratory anatomy and physiology 呼吸系統(tǒng)之解剖及生理呼吸系統(tǒng)之解剖及生理 Importance of observation觀察的重耍性觀察的重耍性 Supplemental oxygen, various施氧的方法施氧的方法 airway adjuncts氣道工具氣道工具 Indications適應(yīng)癥, contraindications禁忌癥, advantages 好處, disadvantages壞處 2Airway - Campbell,Inte

4、rnational Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview概欖概欖 Predictors of difficulty預(yù)知困難預(yù)知困難 氣管內(nèi)導(dǎo)管氣管內(nèi)導(dǎo)管 Mask ventilation and endotracheal intubation 面罩呼吸 Sellick maneuver Essential components of airway kit 氣道處理工具包氣道處理工具包 3Airway - Campbell,International T

5、rauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Initial Airway Management 氣道初步處理氣道初步處理 Most important trauma care task 為處理創(chuàng)傷時(shí)最重要之工作為處理創(chuàng)傷時(shí)最重要之工作 Challenging in field具挑戰(zhàn)性 Frequently time critical時(shí)間是非常重要 Unpredictable難以估計(jì) Need options and alternatives 需使用各種虧法 Always sta

6、rt with basics 先施行基本氣道處理 4Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 解剖生理解剖生理 5Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and P

7、hysiology 解剖生理解剖生理 6Airway - Nasopharynx鼻咽鼻咽 Delicate Turbinates Oropharynx口咽口咽 Hyoid bone Hypopharynx下咽喉下咽喉 Epiglottis Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 解剖生理解剖生理 7Airway - Larynx咽喉咽喉 Laryngeal prominence隆突

8、處 Vocal cords聲帶 Thyroid cartilage甲狀軟骨 Cricoid cartilage環(huán)狀軟骨 Sellick maneuver Cricothyroid membrane 環(huán)狀甲狀軟骨膜 Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 解剖生理解剖生理 Trachea氣管氣管, bronchi支氣管支氣管 Carina氣管分義 Mainstem bronchi主要

9、支氣管 Protective reflexes 咳嗽反射 Lungs Pleural space胸膜腔 Alveolocapillary membrane 肺泡膜 8Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Average Adult一般成人一般成人 Distances can vary by several cm. 22.5 cm movement in flexion屈曲屈曲/ extension伸展伸展

10、9Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Patent Airway暢通氣道暢通氣道 Airway - 10 Without a patent airway, all other care is of little use. 暢通氣道是最重要暢通氣道是最重要 Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education,

11、Inc., Upper Saddle River, NJ Patent Airway暢通氣道暢通氣道 Continual observation繼續(xù)觀察繼續(xù)觀察 Suction with large-bore tubing用大口徑抽用大口徑抽 痰管痰管 Airway adjuncts氣道設(shè)施氣道設(shè)施 Nasopharyngeal airway鼻咽氣道 Oropharyngeal airway口咽氣道 Blind insertion airway device (BIAD) Endotracheal intubation氣管內(nèi)導(dǎo)管 11Airway - Campbell,Internationa

12、l Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Difficult Airway Rapid sequence intubation (RSI)快速痳醉快速痳醉 BVM ventilation and immediate transport輔助呼吸 Assessment of difficult airway Remember MMAP MMallampati MMeasurement 3-3-1 AAtlanto-occipital extension PPathology

13、 12Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ MMAP: Mallampati Score 13Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ MMAP Measurement 3-3-1 Chin to hyoid bone Op

14、ening of mouth Lower-jaw protrusion突出 Atlanto-occipital extension Only if cervical-spine injury not suspected Pathology Anatomic airway obstructions 14Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Patent Airway暢通氣道暢通氣道 Airway - 15 N

15、oisy breathing is obstructed breathing. 呼吸有雜音代表呼吸道阻塞呼吸有雜音代表呼吸道阻塞 Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Normal Perfusion正常血液灌注正常血液灌注 Normal oxygenation動(dòng)脈血含氧量動(dòng)脈血含氧量 PaO2: 100 mmHg Pulse oximetry血含氧量血含氧量 Goal: maintain SpO2 95% Monitor

16、SpO2 with all trauma patients Monitor SpO2 with any respiratory compromise 16Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Supplemental Oxygen施氧施氧 % Oxygen DeviceFlow Rate 4050%Simple Face Mask面罩1012 lpm 6090%NRB Face Mask 高氣濃度面罩 12

17、15 lpm 2530%Nasal Cannula鼻導(dǎo)管26 lpm 4050%BVM1215 lpm 90100%BVM with Reservoir Bag1215 lpm 100%FRPPVD氧氣機(jī)40 lpm 17Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Normal Ventilation正常換氣正常換氣(呼吸呼吸) Tidal volume (VT) Amount moved with each b

18、reath 400 to 600cc (adult) VT x breaths/minute = Minute volume 500cc x 12 breaths/min = 6 liters/min (adult) Fast, shallow:250cc x 24 breaths/min = 6 liters/min Slow, deep:750cc x 8 breaths/min = 6 liters/min 18Airway - 潮氣量潮氣量 分鐘流量分鐘流量 Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson

19、 Education, Inc., Upper Saddle River, NJ Normal Ventilation正常換氣正常換氣(呼吸呼吸) Normal ventilation正常換氣正常換氣 Carbon dioxide in blood血含二氧化碳 (pCO2) 3540 mmHg Abnormal ventilation不正常換氣不正常換氣 Hypoventilation換氣過(guò)慢: pCO2 above 40 mmHg Hyperventilation換氣過(guò)快: pCO2 below 35 mmHg Capnography 量度呼氣二氧化碳量量度呼氣二氧化碳量 End-tidal

20、 CO2呼氣二氧化碳量(EtCO2) relates directly to pCO2 19Airway - Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ 20Airway - When in doubt, give oxygen! 如有懷疑如有懷疑,給與氧給與氧 氣氣! Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc.,

21、 Upper Saddle River, NJ Positive Pressure正壓呼吸正壓呼吸 Ventilation rate換氣次數(shù)換氣次數(shù) 1012 per minuteNon-intubated patient 810 per minuteIntubated patient Supplemental oxygen essential Suction must be immediately available吸痰吸痰 Avoid gastric distention避免胃氣脹避免胃氣脹 Monitor lung compliance 21Airway - Campbell,Inter

22、national Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Perfusion and Ventilation 血液灌注及換氣血液灌注及換氣 22 Pulse oximetry (SpO2) monitors oxygenation血含氧 量 Monitor effectiveness Airway - Capnography (EtCO2) monitors ventilation呼氣二 氧化碳含量 Campbell,International Trauma Life S

23、upport, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ B Beards胡子胡子 O Obesity肥胖肥胖 O Older patients長(zhǎng)者長(zhǎng)者 T Toothlessness無(wú)牙齒無(wú)牙齒 S Snores or stridor喘嗚音喘嗚音 23Airway - Difficult BVM Ventilation Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ Airway Kit處理氣道裝備處理氣道裝備 A