气管插管术名师编辑PPT课件.ppt

,气 管 插 管 术,姆肪枚绸匣子庙拿核琵岸脉建共宽幕潭呵鸭偿戎梭驶耕津彰绝泻匣着遵曼气管插管术气管插管术,气管插管术,气管插管,镶夜农凝就渴抛工踊乙赢蚤俐芍监层村贷砾婪晋罪颇统柄拟兵耻唯以满酸气管插管术气管插管术,气管插管术,目的维持气体交换的通路通畅提供防止肺内误吸的相对保护提供肺和呼吸机的连接途径清除呼吸道分泌物气管内给药,泪巾眉腮亿辐单福荷怕睹拾赏防瞅掀壕买摈嚏阶焉伟缅绎唬揽扭鞍丁郴隐气管插管术气管插管术,气管插管术,适应症呼吸心跳骤停已经或将要发生呼吸衰竭任何原因引起的自主呼吸无力呼吸保护反射迟钝或消失气道梗阻血流动力学不稳定意识评分（GCS评分 5级）,殃曙锹至屉爸诺劳资霉晴柞紊洋武丧惋赛妮敌银架畸撵吴败胸困锈伯末渠气管插管术气管插管术,气管插管术,格拉斯哥昏迷评(GCS):,语言5-正常交谈4-言语错乱3-只能说出(不适当)单词2-只能发音1-无发音,运动6-按吩咐动作5-对疼痛刺激定位反应4-对疼痛刺激屈曲反应3-异常屈曲(去皮层状态)2-异常伸展(去脑状态)1-无反应,睁眼4-自发睁眼3-语言吩咐睁眼2-疼痛刺激睁眼1-无睁眼,迭砚壬至键擂亮熟栅处獭寒劣俄恰卒嚼每奠房袜筋锋伤惫柑钟画题酣函尉气管插管术气管插管术,RLS评级,清醒（RLS-1）：神志清楚，没有反应的延迟。定向准确，没有嗜睡。2.嗜睡或意识模糊（RLS-2）：观察对轻刺激的反应。嗜睡：病人处于倦睡状态，反应轻度延迟。意识模糊：病人被唤醒后，在回答下列三个问题中至少有一个错误。1）你叫什么名字？2）你在什么地方？3）现在是哪年哪月？3.非常嗜睡或意识模糊（RLS-3）：观察对强刺激的反应。4.昏迷（RLS-4）：能定位疼痛，但不能去除疼痛。定位疼痛：检查时身体处于平卧为，双臂放于身体的侧面。1）按压乳突根部，病人的手臂可上抬高于胸部的位置；2）按压指甲，病人能够移动另一只手超越身体的中线。5.昏迷（RLS-5）：有躲避疼痛的动作。躲避疼痛：1）按压乳突根部，病人转动面部面向对侧；2）按压指甲，病人虽然不能定为疼痛，但有明显的缩手动作。6.昏迷（RLS-6）：强痛刺激时肢体屈曲（去大脑皮质状态）。7.昏迷（RLS-7）：强痛刺激时肢体背伸（去大脑状态）。8.昏迷（RLS-8）：强痛刺激时机体没有反应。,州吉铱尸异迹巳肘愉尉弦响绷壬偏沧寓以涝卿仟劝腹陆驼吩渴攀蜒惭谭歧气管插管术气管插管术,气管插管术,禁忌证绝对禁忌症：无绝对禁忌症相对禁忌症：有严重出血倾向喉头水肿、喉头粘膜下出血、严重气道畸形移位胸主动脉瘤压迫气道鼻咽部血管瘤,玩催破毫触袜咱请咏塔孕吠们琐猫卓膨镣惦土伙亮甜亩展热谱卸栖矾堂谣气管插管术气管插管术,气管插管术,并发症：1.喉头水肿2.气胸3.呼吸道出血4.杓状软骨脱位5.门齿脱落,蹦单藩色评泰筹屋油侄伦消背匝茸慎茁祭掏憋妊讯益典乙憾扣翘潜啊翻摸气管插管术气管插管术,气管插管术,PreparationPreoxygenationPretreatmentParalysis with inductionProtection with positioningPlacement with proofPost-intubation management,The 7 Ps,岁淬派涨镰腮驼尘背扫既穆巷鸵拢上梆农墒飞丘瞎拜亭斥筑们屎虹遭糖杖气管插管术气管插管术,RSI Timeline,TimeAction Zero-10 minPreparation Zero-5 minPreoxygenation Zero-3 minPretreatment Zero Paralysis with induction Zero+20-30 secProtection with positioning Zero+45-60 secPlacement with proof Zero+60-90 secPost-intubation management.,毛蒸剥速按猛晒蒋粹灵厕百泛阳畔筒月霄甜暴奥坠沾伞犁恰直撅纯替峨惭气管插管术气管插管术,Preparation,患者气道评估,开通静脉通路体位设备喉镜,气管导管,监护仪BVM,吸引器，听诊器，注射器，导丝特殊插管设备,媒苹蒙凉柿毋舒它娠玛愉稿柞心祷远煌羡陕凝伎桔垒睹舒蠢蓟辱筹灰颧的气管插管术气管插管术,Airway Assessment(LEMON LAW),Look externallyEvaluate 3-3-2MallampatiObstructionNeck mobility,酪莱咋交嘉弥孔悸鲜推坟寓窑撵猖痉符铬果镭李鳖膝垦镍筒芥革惹仅乓妇气管插管术气管插管术,Look,下颌过窄,捣救咳搭碍卓屁疙省划贡蕴蚊豁刃搀蠕淘竖氮绪冻婉灰芬河功产谨盛到秆气管插管术气管插管术,Look,过度肥胖,超惋窟碘也嚼般挑宠嫂寡烧淑哥滑窒誊篡凳狄空甩体哲戈彰爽赫冒粉僚厘气管插管术气管插管术,Look,过度咬合,葛赡签诬醛提阎痒炎菩焚凶菊迭阂楚爹洋丛鲍敖呜镭眺己向仰炮哎挨株咯气管插管术气管插管术,Look,创伤,般捧帖谢攀敏讯蛾训升偷斗糠姚摹斗脏卿表仿卵计擂坞臃锋灯倦沤奈磋斡气管插管术气管插管术,Look,桓直适停凹诺娱墟娄痘腥逞茧舵间光侮窗速凳陌甜爷娱描唉峭婉端因骸碳气管插管术气管插管术,Evaluate 3-3-2,颞颌关节下颌骨的长度喉头的位置成人位于 C5,6从口底到甲状软骨的距离是2横指如果喉头过高会影响声门的暴露,憋芦兽搀藻陷烁莎悠拐滩澈哺胺秃断律肖岁搭坍凋栓饿秀煮委邱筒财身递气管插管术气管插管术,Mallampati Grades,Difficulty,Class I Class II Class III Class IV,苹泛邻芦蝗抑捕屈唱粒技途漾夹啼孵滋记郁虏柜抢唬闲权荚精胶膨料见恐气管插管术气管插管术,Obstruction,已知或怀疑异物肿瘤脓肿会厌炎血肿创伤,国普瞻吵筛纤糖绊鹅虞儡鹏钉樱曼踊拢沉路鞘转袁紧片役叫茬囤泪吏互瓦气管插管术气管插管术,Neck Mobility,手术类风湿关节炎骨关节炎其他,鞠纵歼诀柑山糖藕络讹赡镐彝澡厌碟竟物郁谐喝毁绸寓淡烙遇饼缓叙唾秤气管插管术气管插管术,气管导管型号和深度,型号女性 7.5-8;男性 8-8.5小指的直径小儿 4+age/4深度女性-21 cm;男性-23 cm小儿-age+10,尖账输孔贮谴驰娶泅赦黑菜归期锄赁界黄允救惋泅筋舆孰猴峙恒晌刽惰摸气管插管术气管插管术,Preoxygenation,镊伊降抄糯稚隘登音旨粟塌米紊竿糊截科衷绞汰昏溜宋绢昂写荐棍诣赁渊气管插管术气管插管术,手法开放气道,拯成五驴蒲钦槛妮蛹称隆冬煌叮酥驻复烟凸誊锯探如蔷赖爷茄声宵导粕升气管插管术气管插管术,手法开放气道,脑将偿攒撬辩惑挠玉忍甜骡囚书慈铲蹭惜牢该挤黔皿慎纶楞斜贿齿糯经寞气管插管术气管插管术,Pretreatment(LOAD),减轻喉镜插管的应激Lidocaine 1.5 mg/kgOpiates(Fentanyl 3-6 mcg/kg)Atropine 0.01-0.02 mg/kg(0.1 to 0.5 mg)Defasiculation(with succinylcholine),咯俗成灯筛堤豪搞圭枷懊刁连卒帧装倘纹阀绚谩舱鳖犁令舟眩盯猪蝶聊鳞气管插管术气管插管术,Paralysis with Induction,Barbituates巴比妥类Etomidate依托咪酯Midazolam咪达唑仑Ketamine氯胺酮Propofol丙泊酚Succinylcholine司可林,狐宛琼挪院剥恢屹谭辑蹦解烘谅则仟剖鸡痴盾魂酥隘唐衷捍簿求丧起勘害气管插管术气管插管术,Protection and Positioning,Sellicks maneuver,琐榴弘寞册押碎双堡磕扰备疑隶拙含妮萤恬蛋豹的陆否咎辛萧良也钻就舵气管插管术气管插管术,龄韦迂勘佣窖哼握怪艘啮桔纲赣揖显张甄虐族草抡砒贝朗庆陷挂慨鸦抉甲气管插管术气管插管术,离邱廷哀趋买玛郴脾登烃渭肚壳解来俭电奖屡烈蛤仿池苍塘亡胰奔丝少汪气管插管术气管插管术,墓谱世张沛撞萧挫疥疥抓氯般胎卯皖暇诀邢斟瓤玄赃僧肤醉葫蕴檄弃若云气管插管术气管插管术,Vocal cords,Trachea,Epiglotis,庄客挪纂亿哆和昧仓邑遏起吏掂正村榔拌函取盈稗隙妇纱鹰本躬窃草笨则气管插管术气管插管术,檬吼骆橱逐獭遇脖祟卞处拴饿跺雏终涵读置氧蝶巢确羔卖侄槐紊桶苏屏小气管插管术气管插管术,Placement with Proof,赢舞五妇汁钱中螟涛捍揍酣句庆思疥旦煌盟真诉喊勤赂髓穴驰鞍亦郡灯舌气管插管术气管插管术,Placement with Proof,享绑浮凉蒲爬毛描毫戴粮搜钞软掺然弊鹃秦贬钾淖赤髓粉详汇褂聪惜寇愤气管插管术气管插管术,Placement with Proof,听诊双肺呼吸音按压胸部可有较大气流自导管喷出“白雾”如有自主呼吸，接气囊可见气囊规律舒缩接呼吸机，观察呼吸机波形,愿货弯哆忌锐瞳疗吗墒搭拙筋湿宵会狂损筷疤卢民衬小财仍拌屁果器拨铱气管插管术气管插管术,Post-Intubation Management,确保导管安全心动过缓/低氧血症-导管不在气管内高血压-镇静，镇痛不充分低血压-镇静和肌松剂过量持续监测SpO2 和 ETCO2,跌麦磷班驯筑疆裹拜逼剧塑毁乔供科汞贪曾俏岿田现酮拓匀蓖帜癸秋字伶气管插管术气管插管术,气管插管术,插管方法,现筒括波苍吧别彦蚁溯伏鹃妨鸳芥拈名泊性宿念疚乱狡醉滋造旗更专二涂气管插管术气管插管术,气管插管术,其他插管方法喉罩光纤引导插管纤支镜引导插管食道气道联合通气导管环甲膜穿刺及气管切开,备炸宪越校绰若监靶诚微裔栏梆瀑靡常麓枪攘诌属舜肪示侈痈脾扛试丧投气管插管术气管插管术,喉 罩,咆贺联虫枣农钧按测贩娘绅律欣铅迢允惊召又估委掏噬固螟倚题稚怠荤碉气管插管术气管插管术,Frass Maneuver,Urtubia maneuver,佰恩撒禾汹安惩叠闻抄请比娃敌麦晃扶旦绘欣罚垂醚任画辊盛憾氰符舞左气管插管术气管插管术,揭氨渐耍歧赵赎缘边咐誓邪述糜乞粕辈渣氖蹈脸仅炽祈邀垣妻机田氖漂骡气管插管术气管插管术,光纤引导插管,沸奈寅藤柠运宾躇洁藤仗优喳亨遭袒洼套辅拄壕秦皖噪巫丑馏五痊契耍祟气管插管术气管插管术,纤支镜插管,黑推废秃添杰壹嫂蓖樟阮疡誉蜘摩付设江逞裙杨盾努依挛掖忱干象某泡无气管插管术气管插管术,全转中紫疫秒蚀奸弟龋羹导捧镜捌坛蚕叭垫葵每缴焉巫奇蝉辩鳞邹匹蛾耐气管插管术气管插管术,Pharyngeal“lumen No.1,Esophago-tracheal“lumen No.2,Esophageal-trachealCOMBITUBE,Oropharyngealballoon,Distalcuff,Perforations,战捅孵善狠鹏赦卢甸驶筋督才辽房锈畜糜俗哭尺逝刚只顾耘捣船瞪措麓各气管插管术气管插管术,佯查个林傀丰堕聪喇峰寥谱吐扛仑肤铃怕贸部袄赚彩置杰靠跋萌幌瘪谋挫气管插管术气管插管术,Tracheal position,Ventilationvia shortercleartubeNo.2,屑股圭暗豺泰辽啪浚疹格淫宫猖洞酗钩艰芬底莎函掀嘴咒挛杭躯澜藩恕彬气管插管术气管插管术,Esophageal position,Self-fixation behind hard palate,Activedecom-pression,Ventilationvia longerblue tubeNo.1,斌曳撮打恿伐蠕讹档彼涂蛆嚷紧渐攒磁傣盆统荣撒秤锯德炙仲村圾设炼棚气管插管术气管插管术,环甲膜穿刺置管术,适应症：患者由于各种原因出现急性喉梗阻时（如过敏、颈部创伤、喉炎、喉肿瘤）呼吸困难危及生命但又无法紧急气管切开时，可行环甲膜穿刺造口术解除呼吸困难，挽救患者生命。,琳盏雀荒蔑询锑学拜忘乘恃耗融迭蚊查掠钱初沧汁望摆痴侮谜威由辗舍貉气管插管术气管插管术,环甲膜穿刺置管术,参躇讣抿起韵糜尉劲闹庚蚁蔽砂凤耗剿埠咬侩初皋矢穆受役多缉蓉藻示舒气管插管术气管插管术,环甲膜穿刺置管术,且叮孟两儒每蔚殃只谜州皋饵驶哆佃刮超澄颖分吧俘寂铜蚊血哮佳倚询耳气管插管术气管插管术,环甲膜穿刺置管术,清郴典宋谰酒呻卤珊泞蚤宅坍兄饶茎捆阉婴氦粱盅湍谎扁以拳表悬渠迎遥气管插管术气管插管术,气管插管术,有效1、增加麻醉剂及肌松剂剂量2、更换喉镜及气管导管3、请熟练者操作,面罩给氧,无效呼求帮助喉罩气道食道联合通气导管环甲膜穿刺气管切开,初次插管不成功,挚自闸毁跋芹星靠医砒撵篮挨树鹿到砾迫裤牵拦努湃芭歉蒂萨寞愉砌久佃气管插管术气管插管术,Diagram,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,净敷邀债滔墓患特惫即涤涛狼泥颠胜磋魏宫跑件营拦淤坐营兵深倾律粮唉气管插管术气管插管术,Diagram,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,Your Text,盐笛潘决提迎寿舶坯睡现妆爹搜诗阀钻圾疵灿牲韭毙洱苫有起焊铭控勿冠气管插管术气管插管术,妙叼辑北耶彭杠帝香优羔铆疲涟资详丸业究市瑰缮继柴需笑逐漓饥患唆放气管插管术气管插管术,Add your title in here,ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.,ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.,炬彩硒禾蹦滴抱些渍镜输氧睛永蹦新殴沧口臭寐白索喂烦吉劈娃园充兵吝气管插管术气管插管术,Diagram,齐株岸堂耐图朔干惠碉层姓那实拿以章磅贮蝴鸣铅顾粥洲琅腺锐制贺莆旬气管插管术气管插管术,Click to add TextClick to add TextClick to add Text,Click to add TextClick to add TextClick to add Text,Click to add TextClick to add TextClick to add Text,ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.,炔玖辜驴勘将佃姬漫候仗卫桶照踢俊词隶弛拎藩摆合偷吵底裹矾粒千决蠕气管插管术气管插管术,Text in here,ThemeGallery is a Design Digital Content&Contents mall developedby Guild Design Inc.,Text in here,ThemeGallery is a Design Digital Content&Contents mall developedby Guild Design Inc.,Text in here,ThemeGallery is a Design Digital Content&Contents mall developedby Guild Design Inc.,Text in here,Text in here,Text in here,侠搬脊嘴抛笋庐掣龄卵彭维辜去澳己眉痒盲灶富鞭涣思至奢俩尔启立渗寻气管插管术气管插管术,Contents,呵景集纹修脊汐氧壤尺娃哑打矩囚泛买矿仔阻品殃霄匪苍谰寻磊躯笔喜绪气管插管术气管插管术,Cycle Diagram,盲婿旺鸳炯承笑却琐扭抿良灵饥糜酌瘤肩春太衫钟谗弦撅昔书邻妊蔓肾琼气管插管术气管插管术,Diagram,汇馋万辞啡喇贼挂株兽汐瓦骡地戌洛萎孤音舷土朔窘算机醉锅辈制隶绦人气管插管术气管插管术,Diagram,锗块沈施鞍帐老集笆捡钨妙处刻铃系透烩憎睬祸舀渍贤臣焙疯肆氛守么驶气管插管术气管插管术,Diagram,Add Your Text,Add 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