气道的评估和管理Airway-Evaluation-and-Management
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airway management. B. Physical Examination
1. Specific findings that may indicate a difficult airway include the following: a. Inability to open the mouth. b. Poor cervical spine mobility. c. Receding chin (micrognathia).
basilar skull fracture, or intracranial injury.
6. Previous surgery, radiation, or burns may produce scarring, contractures,
and limited tissue mobility.
visible. b. Class II. Faucial pillars and soft palate may be seen,
but the uvula is masked by the base of the tongue. c. Class III. Only soft palate is visible. Intubation is
not at risk for regurgitation of gastric contents.
2 .Mask placement.
with one hand
with two hands
predicted to be difficult. d. Class IV. Soft palate is not visible. Intubation is
predicted to be difficult.
III. MASK AIRWAY
A. Indications 1. To preoxygenate (denitrogenate) a patient before
endotracheal intubation. 2. To assist or control ventilation as part of initial
resuscitation before an ETT is placed. 3. To provide inhalation anesthesia in patients
tracheal deviation. 4. Morbid obesity is associated with difficult airway m anagement.
II. EVALUATION
5. Trauma may be associated with airway injuries, cervical spine injury,
7. Acromegaly may cause mandibular hypertrophy and overgrowth and enlargement of the tongue and epiglottis.
8. Scleroderma may produce skin tightness and decrease mandibular motion and narrow the oral aperture.
1. Arthritis or cervical disk disease may decrease neck mobility. 2. Infections of the floor of the mouth, salivary glands, tonsils, or
pharynx may cause pain, edema, and trismus with li mited mouth opening. 3. Tumors may obstruct the airway or cause extrinsic compression and
II. EVALUATION
d. Large tongue (macroglossia). e. Prominent incisors. f. Short muscular neck. 2. Injuries to the face, neck, or chest must be evaluated to assess their contribution to airway compromise. 3. Head and neck examination. There is no single best predictor of difficult airway management on the physical exam, so a detailed exam is in order.
4. The Mallampati classification
The modified classificationr categories (Fig. 13.1): a. Class I. Faucial pillars, soft palate, and uvula are
II. EVALUATION
9. Trisomy 21 patients may have atlantoaxial instability and macroglossia.
10. Dwarfism. 11. Other congenital anomalies may complicate
Airway Evaluation and Management
II. EVALUATION
A. History. A history of difficult airway management in the past may be the best predictor of a challenging airway.
1. Specific findings that may indicate a difficult airway include the following: a. Inability to open the mouth. b. Poor cervical spine mobility. c. Receding chin (micrognathia).
basilar skull fracture, or intracranial injury.
6. Previous surgery, radiation, or burns may produce scarring, contractures,
and limited tissue mobility.
visible. b. Class II. Faucial pillars and soft palate may be seen,
but the uvula is masked by the base of the tongue. c. Class III. Only soft palate is visible. Intubation is
not at risk for regurgitation of gastric contents.
2 .Mask placement.
with one hand
with two hands
predicted to be difficult. d. Class IV. Soft palate is not visible. Intubation is
predicted to be difficult.
III. MASK AIRWAY
A. Indications 1. To preoxygenate (denitrogenate) a patient before
endotracheal intubation. 2. To assist or control ventilation as part of initial
resuscitation before an ETT is placed. 3. To provide inhalation anesthesia in patients
tracheal deviation. 4. Morbid obesity is associated with difficult airway m anagement.
II. EVALUATION
5. Trauma may be associated with airway injuries, cervical spine injury,
7. Acromegaly may cause mandibular hypertrophy and overgrowth and enlargement of the tongue and epiglottis.
8. Scleroderma may produce skin tightness and decrease mandibular motion and narrow the oral aperture.
1. Arthritis or cervical disk disease may decrease neck mobility. 2. Infections of the floor of the mouth, salivary glands, tonsils, or
pharynx may cause pain, edema, and trismus with li mited mouth opening. 3. Tumors may obstruct the airway or cause extrinsic compression and
II. EVALUATION
d. Large tongue (macroglossia). e. Prominent incisors. f. Short muscular neck. 2. Injuries to the face, neck, or chest must be evaluated to assess their contribution to airway compromise. 3. Head and neck examination. There is no single best predictor of difficult airway management on the physical exam, so a detailed exam is in order.
4. The Mallampati classification
The modified classificationr categories (Fig. 13.1): a. Class I. Faucial pillars, soft palate, and uvula are
II. EVALUATION
9. Trisomy 21 patients may have atlantoaxial instability and macroglossia.
10. Dwarfism. 11. Other congenital anomalies may complicate
Airway Evaluation and Management
II. EVALUATION
A. History. A history of difficult airway management in the past may be the best predictor of a challenging airway.