呼吸道通气方法ALS

1、airway & ventilation methods: alspharmacologic assisted intubation (“rsi”)neuromuscular blockade contraindicationsmost are specific to the medicationinability to ventilate patient once paralysis is inducedadvantagesenables to provider to intubate patients who otherwise would be difficult or impo

2、ssible to intubateminimizes patient resistance to intubationreduces risk of laryngospasmairway & ventilation methods: alspharmacologic assisted intubation (“rsi”)mechanism of action for nmb agentacts at the neuromuscular junction where ach normally allows nerve impulse transmissionbinds to nicot

3、inic receptor sites at skeletal muscledepolarizes or does not depolarize specific to medblocks further action by ach at receptor sitestherefore, blocks further depolarization resulting in muscular paralysisairway & ventilation methods: alspharmacologic assisted intubation (“rsi”)disadvantages &a

4、mp; potential complicationsdoes not provide sedation or amnesiaprovider unable to intubate or ventilate after nmbaspiration during proceduredifficult to detect motor seizure activityside effects and adverse effects of specific medsairway & ventilation methods: alspharmacologic assisted intubatio

5、n (“rsi”)common used nmb agentsdepolarizing nmb agentssuccinylcholine (anectine)non-depolarizing nmb agentsvecuronium (norcuron)rocuronium (zemuron)pancuronium (pavulon)airway & ventilation methods: alspharmacologic assisted intubation (“rsi”)summarized procedureprep all equipment and medication

6、s while ventilating patienthyperventilate administer induction/sedation agents & pretreatment meds (e.g. lidocaine or atropine)administer nmb agentsellick maneuverintubate per usualcontinue nmb and sedation/analgesia prnairway & ventilation methods: alsexamples ofsecondary tube placement con

7、firmation devices(from amls, naemt)from amls, naemtairway & ventilation methods: alsneedle thoracostomy (chest decompression)indicationspositive sx/sx of tension pneumothoraxcardiac arrest with pea or asystole when the possibility of trauma and/or tension pneumo existcontraindicationsabsence of

8、indicationsairway & ventilation methods: alstension pneumothoraxsx/sxsevere respiratory distress or absent lung sounds (unilateral usually) resistance to manual ventilationcardiovascular collapse (shock)asymmetric chest expansionanxiety, restlessness or cyanosis (late)jvd or tracheal deviation (

9、late)airway & ventilation methods: alsneedle thoracostomyprep equipmentlocate landmarks: 2nd intercostal space at midclavicular lineone-way valveairway & ventilation methods: alschest escharotomyindicationsin the presence of severe edema to the soft tissue of the thorax as with circumferenti

10、al burns:inability to maintain adequate tidal volume even with ppvinability to obtain adequate chest expansion with ppvrarely neededairway & ventilation methods: alschest escharotomyconsiderationsmust rule out the possibility of upper airway obstructionprocedureintubate if not already doneprep s

11、ite and equipmentvertical incision to anterior axillary linehorizontal incision only if necessarycover and protectairway & ventilation: risks & protective measuresbsiglovesface & eye shieldsrespirator if concern for airborne diseasebe prepared forcoughingspittingvomitingbitingairway & ventilation methodss