1、 快速程序诱导Rapid Sequence Induction南京市第一医院鲍红光病 例（Case Insert） A 38 year old female，女性 38岁 Peritonitis for 3 days 腹膜炎3天 Shocked with: 休克：1. T: 38 o C 体温：382. Pulse:120/minute 脉搏：120次/分3. BP: 70 mmHg systolic 血压：收缩压 70mmHg4. Poor nail bed capillary return 末？回流差5. Respiratory rate 呼吸：30次/分6. Confused 烦躁7.
2、Urinary: 20mL of concentrated urine 尿量: 20mL 的浓缩尿 The surgeon wants to operate immediately 外科医生准备尽快手术 麻醉方式？Anesthesia ? regional anesthesia?硬膜外麻醉？ General anesthesia?全身麻醉？诱 导Induction芬太尼 Fentanyl异丙酚 Propofol罗库溴胺 Rocuronium快速诱导插管 RSI快速顺序插管Rapid Sequence Intubation1. INDUCTION2. PRESSURE3. PARALYSIS插
3、INTUBATION管病 例（Cases） 成年病人（Adult patient） 小孩（Child）全身麻醉的主要并发症Main complications of GA Regurgitation 返流 Vomiting 呕吐 Aspiration 误吸 Desaturation, Laryngospasm 喉痉挛, Airway obstruction气道梗阻, Bronchospasm支气管痉挛, Cardiac arrest心跳骤停 快速诱导插管的目的GOAL of RSI保护气道 Protect airway便于插管 Facilitate intubations快速诱导麻醉 Rapi
4、dly induce anesthesiaACEP, 2000History Cricoid cartilage pressure to prevent regurgitation- Sellick1961. First series of ED intubations Taryle, 1979 First series of intubations using succinylcholine in the ED Thompson, 1982 American College of Emergency Physicians (ACEP) RSI policy statement(1997):-
5、 Reaffirmed, 2000“physicians performing RSI should possess training, knowledge, and experience in the techniques and pharmacologic agents used to perform RSI”Today （当 今 ）1.RSI resides in the domain of emergency medicine practice 主要应用于急诊医学领域2. Key in the successful management of the “A” of “ABCs心肺复苏“ABC”中“A”的核心3. Increases the chance of successful intubation and minimizes the risks插管的成
