气道通气的识别和评估(英文).ppt
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1、Assessment & Recognition of Airway & Ventilatory Compromise,History Onset sudden vs gradual Known cause? Duration Constant Recurrent Provocation/Palliation,Assessment & Recognition of Airway & Ventilatory Compromise,Exacerbation Associated Signs/Symptoms Cough, chest pain, fever Interventions past e
2、vals/admits meds ever intubated before?,Assessment & Recognition of Airway & Ventilatory Compromise,Respiratory Patterns Cheyne-Stokes brain stem Kussmaul acidosis Biots increased ICP,Respiratory Patterns Central Neurogenic Hyperventilation increased ICP Agonal brain anoxia,Assessment & Recognition
3、of Airway & Ventilatory Compromise,Inadequate Ventilation body cannot compensate for increased oxygen demand or maintain balance Causes infection trauma brainstem injury toxic inhalation renal failure,Airway & Ventilation Methods: BLS,Supplemental Oxygen increased FiO2 increases available oxygen obj
4、ective is to maximize hemoglobin saturation,Airway & Ventilation Methods: BLS,Oxygen source compressed gas liquid oxygen Regulators Humidifier,Delivery Devices nasal cannula partial rebreather mask non-rebreather mask venturi mask small volume nebulizer,Airway & Ventilation Methods: BLS,Airway Maneu
5、vers Head-tilt/Chin-lift Jaw thrust Sellicks maneuver Other Types tracheostomy with tube tracheostomy with stoma,Airway Devices Oropharyngeal airway Nasopharyngeal airway,Airway & Ventilation Methods: BLS,Mouth to Mouth Mouth to Nose Mouth to Mask One person BVM Two person BVM Three person BVM Flow
6、restricted powered ventilator Transport ventilator,One Person BVM difficult to master mask seal often inadequate may result in inadequate tidal vol gastric distention risk ventilate only until see chest rise,Airway & Ventilation Methods: BLS,Two person BVM most efficient method Useful in C-spine inj
7、 improved mask seal and tidal volume,Three person BVM less utilized used when difficulty with mask seal crowded,Airway & Ventilation Methods: BLS,Flow-restricted, powered ventilator Cardiac sphincter opens at 30 cm H2O high volume/high conc not recommended for children, noncompliant or poor tidal vo
8、lume oxygen delivered on inspiratory effort may cause barotrauma,Airway & Ventilation Methods: BLS,Automatic transport ventilators Not like a “real” ventilator Usually only controls Volume and rate Useful during prolonged ventilation times Not useful in obstructed airway or increased airway resistan
9、ce Frees personnel Can not detect changes,Airway & Ventilation Methods: BLS,Pediatric considerations mask seal force may obstruct airway best if used with jaw thrust BVM sizes: neonate & infant=450 ml + Children 8 yoa require adult BVM just enough volume to see chest rise Squeeze - Release - Release
10、,Airway & Ventilation Methods: BLS,Stoma patients expose stoma pocket mask BVM Seal around stoma site seal mouth and nose if air leak is evident,Airway & Ventilation Methods: BLS,Airway Obstruction Techniques Positioning OPA/NPA Heimlich maneuver Finger sweep with caution Chest Thrusts Chest thrust
11、and back blows for infants Suctioning Direct laryngoscopy,Airway & Ventilation Methods: BLS,Suctioning Manual or Powered devices Suction catheters rigid soft Tracheobronchial suctioning lubricate catheter 3-5 cc sterile water or saline insert catheter until resistance is felt,Airway & Ventilation Me
12、thods: BLS,Gastric Distention Common when ventilating without intubation pressure on diaphragm resistance to BVM ventilation increase time of BVM ventilation,Airway Management: Part 2,EMS Professions Temple College,Airway & Ventilation Methods: ALS,Gastric Tubes nasogastric caution with esophageal d
13、isease or facial trauma tolerated by awake patients but is uncomfortable patient can speak interferes with BVM seal orogastric usually used in unresponsive patients larger tube may be used safe in facial trauma,Airway & Ventilation Methods: ALS,Nasogastric Tube Insertion Select size (french) Measure
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