小中中的異想世界

Indication: 

1.cardiac or respiratory arrest,
2.failure to protect the airwayfrom aspiration,
3.inadequate oxygenation or ventilation
4.existing or anticipated airway obstruction.

Equipment:

1.gloves
2.a protective face shield
3.suction
4.a bag-valve mask
5.endotracheal tube with stylet,
6.a 10-ml syringe
7.a stethoscope,
8.laryngoscopes with appropriate blades

Patient Position:在枕部下墊枕頭 稱為sniffing position

至於原因如下圖 最主要這樣的姿勢可以將病人的喉部跟口腔的角度弄到接近一直線

Rapid sequence intubation:快速插管的順序

1.Equipment Preparation
2.Preoxygenation
3.Sedation: Midazolam 2~5mg, Etomidate 20mg, Propofol 1~2mg/kg
4.Cricoid Pressure:BURP(backward,Upward,Rightward pressure)
5.Muscle Relaxation: Succinylcholine 1.5mg/kg, Onset 60sec,  Duration 4min
6.Intubation
7.Verification of Tube Placement:使用聽診器 或可以用end tidal CO2 monitor(刀房)

插管時 要注意到施力的方向 及辨認清楚vocal cord 才不會弄斷牙齒及食道內插管

插管的困難度分級:grade I最簡單 grade IV最難

Complication:

1.esophageal intubation
2.vomiting and aspiration-->pneumonitis or pneumonia
3.bradycardia, laryngospasm, bronchospasm,and apnea
4.Trauma to teeth, lips, and vocal cords
5.Pneumothroax,Pneumomediastinum

最後來看一段NEJM的示範影片: