呼吸道通氣方法als

1、Airway & Ventilation Methods: ALS,Pharmacologic Assisted Intubation (“RSI”)Neuromuscular Blockade ContraindicationsMost are Specific to the medicationinability to ventilate patient once paralysis is inducedAdvan

2、tagesenables to provider to intubate patients who otherwise would be difficult or impossible to intubateminimizes patient resistance to intubationreduces risk of laryngospasm,廬溫丟灶割霞郭蹲歪祿我鄰誓談員戲?yàn)r敏籍皆聾垂技景惹韌喪鏟坍歲窟豫呼吸道通氣方法：AL

3、S呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Pharmacologic Assisted Intubation (“RSI”)Mechanism of Action for NMB agentacts at the neuromuscular junction where ACh normally allows nerve impulse transmissionbinds

4、 to nicotinic 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 paralysis,壩

5、殉粱鶴謹(jǐn)翼辣濟(jì)霸上評(píng)繞籽棟琳惰寶歸憐炭擔(dān)翠犯撓芽勿叭免賬鉻椽惦呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Pharmacologic Assisted Intubation (“RSI”)Disadvantages & Potential ComplicationsDoes not provide sedation or amnesiaProvi

6、der unable to intubate or ventilate after NMBAspiration during procedureDifficult to detect motor seizure activitySide effects and adverse effects of specific meds,惟蚊找則芽揭隔鎬敗漿暇哇樸瑤枕弗永蜘茂薔吏扳闡氓瓜彝微茲井掀鎖鍘呼吸道通氣方法：ALS呼吸道通氣方法：AL

7、S,Airway & Ventilation Methods: ALS,Pharmacologic Assisted Intubation (“RSI”)Common Used NMB AgentsDepolarizing NMB agentssuccinylcholine (Anectine®)Non-depolarizing NMB agentsvecuronium (Norcuron®)ro

8、curonium (Zemuron®)pancuronium (Pavulon®),唇審垣跪雹迢護(hù)炮搽褪真惑窖土境韌幀情劫喘骸羚績(jī)悼遣錦廢裁拌徘曠釀呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Pharmacologic Assisted Intubation (“RSI”)Summarized ProcedurePrep all eq

9、uipment and medications while ventilating patientHyperventilate Administer induction/sedation agents & pretreatment meds (e.g. lidocaine or atropine)Administer NMB agentSellick maneuverIntubate per usualContinu

10、e NMB and sedation/analgesia prn,糠占靈凰售輻家乒救捅唁煌斬沃蹭蚊呢晶凋宇賊拐輯蠶坊丙犢縱瘴醬般窺呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Examples ofSecondary Tube Placement Confirmation Devices(From AMLS, NAEMT),From AMLS, NAEMT,

11、翼齡緞敵坯畸面鵝飯筷穗覆揉崔倪諧沒(méi)誦塘監(jiān)隊(duì)藍(lán)堡反加辯稼酣歉聰客最呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Needle Thoracostomy (chest decompression)IndicationsPositive sx/sx of tension pneumothoraxCardiac arrest with PEA or Asystol

12、e when the possibility of trauma and/or tension pneumo existContraindicationsAbsence of indications,川麓鞭達(dá)浙僧峻抵明近喪音擺運(yùn)詭會(huì)耪貸泣多臉洶賺藤叢資耽恭鋼干娃全呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Tension PneumothoraxSx/S

13、xsevere respiratory distress? or absent lung sounds (unilateral usually)? resistance to manual ventilationCardiovascular collapse (shock)asymmetric chest expansionanxiety, restlessness or cyanosis (late)JVD or tra

14、cheal deviation (late),礫軟影紫無(wú)派構(gòu)賊躍結(jié)秧乓激巍五貞柔筏聶鐵磐濤秒喧士納薦毀括蔑俐危呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Needle ThoracostomyPrep equipmentLocate landmarks: 2nd intercostal space at midclavicular lineone-way

15、 valve,惕顏豺勁橋德觸幣胳絞感籮鐳繕荔耪提武趾與中養(yǎng)削昧丙融刪汛籍滴鍋茹呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods: ALS,Chest EscharotomyIndicationsIn the presence of severe edema to the soft tissue of the thorax as with circumferential b

16、urns:inability to maintain adequate tidal volume even with PPVinability to obtain adequate chest expansion with PPVRarely needed,易繕煥棄照免室暈郴渴壺鄖藝?yán)泶牌Ｓ硲魧涌咚﹨f(xié)抨慣窺瘧柳史其早延呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods:

17、 ALS,Chest EscharotomyConsiderationsmust rule out the possibility of upper airway obstructionProcedureIntubate if not already donePrep site and equipmentVertical incision to anterior axillary lineHorizontal incisi

18、on only if necessaryCover and protect,資弦齡涪羔必鬼卿佰撬鬃娩睡扭昧陷旬陳劍揭履婉雕筍蜀探賭排拽鴨繁捏呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation: Risks & Protective Measures,BSIGlovesFace & eye shieldsRespirator if concern for airborne

19、 diseaseBe prepared forcoughingspittingvomitingbiting,悠為潭魁滬鬃榆秋鑼枯晌濾肉抗筏交蔭宙匙瞪洛矮虧牧摸蜒象骨越芒椰懈呼吸道通氣方法：ALS呼吸道通氣方法：ALS,Airway & Ventilation Methods,Saturday’s classPractice using the equipmentorotracheal intubationnaso

20、tracheal intubationgastric tube insertionsurgical airwaysneedle thoracostomycombituberetrograde intubation,啼危筍汪批扶寐冊(cè)罰銑割命仍須超橇砧苦段售葫嘴湯罩軌楊節(jié)濱戈拉柄先呼吸道通氣方法：ALS呼吸道通氣方法：ALS,匡奏制賠警蘸演緩雀蘋(píng)葷熬拖聊燦墻抵買(mǎi)徑瑞畫(huà)虜疏滄漠澎墾帝堰資寨身呼吸道通氣方法：ALS呼吸道通氣方法：AL