国际创伤生命支持ITLS-03-气道处理Chapter4_Airway_SC

Patent Airway畅通气道
Without a patent airway, all other care is of little use. 畅通气道是最重要
Airway - 10 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology 解剖生理
Airway - 5 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology 解剖生理 Nasopharynx鼻咽
Airway - 12 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
MMAP: Mallampati Score
Airway - 13 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Patent Airway畅通气道
Noisy breathing is obstructed breathing. 呼吸有杂音代表呼吸道阻塞
Airway - 15 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
• Carina气管分义 • Mainstem bronchi主要支气管 • Protective reflexes 咳嗽反射
Lungs
• Pleural space胸膜腔 • Alveolocapillary membrane 肺泡膜
Airway - 8 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Overview概榄
Respiratory anatomy and physiology 呼吸系统之解剖及生理 Importance of observation观察的重耍性 Supplemental oxygen, various施氧的方法 airway adjuncts气道工具
Airway - 16 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Supplemental Oxygen施氧
% Oxygen Device Simple Face Mask面罩 40–50%
• Amount moved with each breath • 400 to 600cc (adult) 分钟流量
VT x breaths/minute = Minute volume
• 500cc x 12 breaths/min = 6 liters/min (adult)
• Blind insertion airway device (BIAD) • Endotracheal intubation气管内导管
Airway - 11 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Chapter 4 Initial Airway Management
Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Initial Airway Management 气道处理
Anatomy and Physiology 解剖生理 Larynx咽喉
• Laryngeal prominence隆突处 • Vocal cords声带
• Thyroid cartilage甲状软骨
• Cricoid cartilage环状软骨
• Sellick maneuver
• Cricothyroid membrane 环状甲状软骨膜
Average Adult一般成人
Distances can vary by several cm.
2–2.5 cm movement in flexion屈曲/ extension伸展
Airway - 9 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
60–90% NRB Face Mask 高气浓度面罩 Nasal Cannula鼻导管 BVM BVM with Reservoir Bag FRPPVD氧气机
Байду номын сангаас
Flow Rate
10–12 lpm 12–15 lpm
25–30%
40–50% 90–100% 100%
2–6 lpm
12–15 lpm 12–15 lpm 40 lpm
Overview概榄
Predictors of difficulty预知困难
气管内导管
• Mask ventilation and endotracheal intubation 面罩呼吸
Sellick maneuver
Essential components of airway kit
气道处理工具包
MMAP
Measurement 3-3-1
• Chin to hyoid bone • Opening of mouth • Lower-jaw protrusion突出
Atlanto-occipital extension
• Only if cervical-spine injury not suspected
Airway - 17 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Normal Ventilation正常换气(呼吸)
Tidal volume (VT) 潮气量
Airway - 3 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Initial Airway Management 气道初步处理
Difficult Airway
Rapid sequence intubation (RSI)快速痳醉
• BVM ventilation and immediate transport辅助呼吸
Assessment of difficult airway
• Remember MMAP
•M •M •A •P Mallampati Measurement 3-3-1 Atlanto-occipital extension Pathology
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 Alabama Chapter, American College of Emergency Physicians
Airway - 7 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology 解剖生理 Trachea气管, bronchi支气管
• Indications适应症, contraindications禁忌症, advantages 好处, disadvantages坏处
Airway - 2 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Patent Airway畅通气道
Continual observation继续观察 Suction with large-bore tubing用大口径抽 痰管
Airway adjuncts气道设施
• Nasopharyngeal airway鼻咽气道
• Oropharyngeal airway口咽气道
Most important trauma care task
为处理创伤时最重要之工作
• Challenging in field具挑战性 • Frequently time critical时间是非常重要 • Unpredictable难以估计 • Need options and alternatives
Normal Perfusion正常血液灌注
Normal oxygenation动脉血含氧量 PaO2: 100 mmHg Pulse oximetry血含氧量
• Goal: maintain SpO2 >95% • Monitor SpO2 with all trauma patients • Monitor SpO2 with any respiratory compromise
• Delicate • Turbinates
Oropharynx口咽
• Hyoid bone
Hypopharynx下咽喉
• Epiglottis
Airway - 6 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
需使用各种亏法
• Always start with basics 先施行基本气道处理
Airway - 4 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Pathology
• Anatomic airway obstructions
Airway - 14 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ