Ebook The walls manual of emergency airway management: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook The walls manual of emergency airway management: Part 2
Ebook The walls manual of emergency airway management: Part 2
SectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2sia and Sedation for Awake IntubationChapterRapid Sequence IntubationCalvin A. Brown III and Ron M. WallsINTRODUCTIONDefinitionRapid sequence intubation (RSI) is the administration, after preoxygenation and patient optimization, of a potent induction agent followed immediately by a rapidly acting ne Ebook The walls manual of emergency airway management: Part 2uromuscular blocking agent (NMBA) to induce unconsciousness and motor paralysis for tracheal intubation. The technique is predicated on the fact thatEbook The walls manual of emergency airway management: Part 2
the patient has not fasted before intubation and, therefore, is at risk for aspiration ol gastric contents. The preoxygenation phase begins before druSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2for positive-pressure ventilation. Likewise, preintubation optimization is a step focused on maximizing patient hemodynamics and overall physiology before RSI drugs are given and is designed predominantly to protect against circulatory collapse during or immediately after the intubation. In other wo Ebook The walls manual of emergency airway management: Part 2rds, the purpose of RSI is to render the patient unconscious and paralyzed and then to intubate the trachea, with the patient as oxygenated and physioEbook The walls manual of emergency airway management: Part 2
logically optimized as possible, without the use of bag-mask ventilation, which may cause gastric distention and increase the risk of aspiration. The SectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2ottic visualization in some cases, and the evidence supporting its use is dubious, at best. As in the fourth edition, we no longer recommend routine use of tliis maneuver during emergency intubation.,1:____4-1_______________IIiiuiiauuna ituu V/U111I aiiiuiiauunaRSI is the cornerstone of emergency ai Ebook The walls manual of emergency airway management: Part 2rway management and is the technique 0Í choice when emergency intubation is indicated, and the patient does not have difficult airway features felt toEbook The walls manual of emergency airway management: Part 2
contraindicate the use of an N.V1BA (sec Chapters 2 and 3). When a contraindication to succinylcholine is present, rocuronium should be used as the NSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2rence, for there are both pros and cons to this approach.TECHNIQUERSĨ can be thought of as a series of discrete steps, referred to as the seven Ps. Although conceptualizing RSĨ as a series of individual actions is helpful when leaching or planning the technique, most emergency intubations require th Ebook The walls manual of emergency airway management: Part 2at several steps, especially leading up to tube placement, occur simultaneously. Tn this latest edition, preintubation optimization has replaced pretrEbook The walls manual of emergency airway management: Part 2
eatment as the third “P” in RSI because a critical reappraisal of the available evidence behind pretreatment agents has failed to identify high-qualitSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2intubation, and positive-pressure ventilation. Otherwise, adding unnecessary drugs contributes to procedural inefficiencies and introduces the potential for adverse drugs reactions and dosing errors. The seven Ps of RSI arc shown in Box 20-1.PreparationBefore initialing the sequence, the patient is Ebook The walls manual of emergency airway management: Part 2thoroughly assessed lor difficulty OÍ intubation (see Chapter 2). fallback plans in the event of tailed intubation arc established, and the necessaryEbook The walls manual of emergency airway management: Part 2
equipment is located. 111C patient is in an area of the emergency department that is organized and equipped for resuscitation. Cardiac monitoring. BP SectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2cularly after intubation, and should be used whenever possible. Hie patient should have at least one. and preferably two, secure, well-functioning intravenous (IV) lines. Pharmacologic agents are drawn up in properly labeled syringes. Vital equipment is tested. A video laryngoscope, if available, sh Ebook The walls manual of emergency airway management: Part 2ould be brought to the bedside and tested for image clarity whether or not it is to be used onfirst attempt. If a direct laryngoscope is to be used, tEbook The walls manual of emergency airway management: Part 2
he blade of choice is affixed to the laryngoscope handle and clicked into the “on" position to ensure that the light functions and is bright. The endoSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2n internal diameter (ID) should also be prepared. Selection and preparation of the tube, as well as the use of the intubating stylet and bougie, are discussed in Chapter 13. Throughout tills preparatory phase, the patient is receiving preoxygenation and optimization measures, if appropriate, as desc Ebook The walls manual of emergency airway management: Part 2ribed in the next two sections.PreoxygenationPreoxygenation is essential to the “no bagging" principle of RSI. Preoxygenation is the establishment ofEbook The walls manual of emergency airway management: Part 2
an oxygen reservoir within the lungs, blood, and body tissue to permit several minutes of apnea to occur without arterial oxygen desaturation. The priSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2laces tills predominantly nitrogenous mixture of room air with oxygen, allowing several minutes of apnea time before hemoglobin saturation decreases to <90% (Fig. 20-1). Similar preoxygenation can be achieved much more rapidly by having the patient take eight vital capacity breaths (the greatest vol Ebook The walls manual of emergency airway management: Part 2ume breaths the patient can take) while receiving 100% oxygen.BOX20-1The seven Ps of RSI.1Preparation2Preoxygenation3Preintubation Optimization4ParalyEbook The walls manual of emergency airway management: Part 2
sis with induction5Positioning6Placement with proof7Postintubation managementObese patients are best preoxygenated when placed upright and oxyhemoglobSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23Anesthes Ebook The walls manual of emergency airway management: Part 2uence. The highest flowSectionPharmacology and Techniques of Airway Management20Rapid Sequence Intubation21Sedative Induction Agents22Neuromuscular Blocking Agents23AnesthesGọi ngay
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