呼吸道通气方法ALS.ppt

1、 Airway & Ventilation Methods: ALSPharmacologic Assisted Intubation (“RSI”) Neuromuscular Blockade Contraindications Most are Specific to the medication inability to ventilate patient once paralysis is induced Advantages enables to provider to intubate patients who otherwise would be difficult or im

2、possible to intubate minimizes patient resistance to intubation reduces risk of laryngospasmAirway & Ventilation Methods: ALSPharmacologic Assisted Intubation (“RSI”) Mechanism of Action for NMB agent acts at the neuromuscular junction where ACh normally allows nerve impulse transmission binds to ni

3、cotinic receptor sites at skeletal muscle depolarizes or does not depolarize specific to med blocks further action by ACh at receptor sites therefore, blocks further depolarization resulting in muscular paralysisAirway & Ventilation Methods: ALSPharmacologic Assisted Intubation (“RSI”) Disadvantages

4、 & Potential Complications Does not provide sedation or amnesia Provider unable to intubate or ventilate after NMB Aspiration during procedure Difficult to detect motor seizure activity Side effects and adverse effects of specific medsAirway & Ventilation Methods: ALSPharmacologic Assisted Intubatio

5、n (“RSI”) Common Used NMB Agents Depolarizing NMB agents succinylcholine (Anectine) Non-depolarizing NMB agents vecuronium (Norcuron) rocuronium (Zemuron) pancuronium (Pavulon)Airway & Ventilation Methods: ALSPharmacologic Assisted Intubation (“RSI”) Summarized Procedure Prep all equipment and medic

6、ations while ventilating patient Hyperventilate Administer induction/sedation agents & pretreatment meds (e.g. lidocaine or atropine) Administer NMB agent Sellick maneuver Intubate per usual Continue NMB and sedation/analgesia prnAirway & Ventilation Methods: ALSExamples ofSecondary Tube Placement C

7、onfirmation Devices(From AMLS, NAEMT)From AMLS, NAEMTAirway & Ventilation Methods: ALSNeedle Thoracostomy (chest decompression) Indications Positive sx/sx of tension pneumothorax Cardiac arrest with PEA or Asystole when the possibility of trauma and/or tension pneumo exist Contraindications Absence

8、of indicationsAirway & Ventilation Methods: ALSTension Pneumothorax Sx/Sx severe respiratory distress or absent lung sounds (unilateral usually) resistance to manual ventilation Cardiovascular collapse (shock) asymmetric chest expansion anxiety, restlessness or cyanosis (late) JVD or tracheal deviat

9、ion (late)Airway & Ventilation Methods: ALSNeedle Thoracostomy Prep equipment Locate landmarks: 2nd intercostal space at midclavicular line one-way valveAirway & Ventilation Methods: ALSChest Escharotomy Indications In the presence of severe edema to the soft tissue of the thorax as with circumferential burns: inability to maintain adequate tidal volume even with PPV inability to obtain adequate chest expansion with PPV Rarely needed