Ngongo Endotracheal (ngongo endotracheal): momo, te rahi, mau opuaraa. Whakatakotoria he hoki intubation

Kia aroha mai, i te whānuitanga o ngā whara me mate e kore e tino tika. I roto i ngā take kino, me te āwhina tonu koe i te tangata i roto i te mamae. Rawa, ki te te pakaru reira, te ora-te whakawehi. Ēnei ngā taua tikanga akiaki pērā i airway tukuna ai, hopu cardiac, ru, pōroa. kia whakahaeretia te maimoatanga o enei pathologies i roto i te kōwae tiaki kaha. Heoi, me mahi tonu kia tangohia tonu i muri i te aro mātai o te manawanui, arā i te wā o te whawhati tata. I roto i te motokā, "waka tūroro" te whakatakotoria mo te tracheal intubation, he defibrillator, Ambu putea. E hiahiatia ana ēnei whakaaro hauora anake i roto i ngā take kino, ka kore e taea manawa takitahi te tangata.

He aha te mea te ngongo endotracheal?

Noatia, e pā ana te intubation tracheal ki ngā tukanga kino. Ko, ahakoa te raruraru, he mea e tika ana mō ngā take hauora. Hei whakawhānui i te Airways me whakarite te whai wāhi o te hāora ki te pūkahukahu, whakaurua te ngongo endotracheal te. Me e taea ki te intubate te tākuta o tetahi taa'e. Rawa Me tenei pūkenga me resuscitators anaesthesiologists, tākuta tūroro. Ki te whakataki o te ventilation endotracheal ngongo pūkahukahu riro ano noa, ahakoa te kino ki te Airways. I tua atu, mā te whakamahi i tenei tikanga e taea te kawea i roto i supply hāora tāwhaiwhai. He maha ngā momo o korere endotracheal (20). rerekē ratou i roto i te rahi me te aroaro o te tikanga atu (kara). E wehea nga taputapu katoa mo te intubation ki 2 momo: ngongo te taheraa a nasotracheal. rerekē ratou i roto i nga ara o te kătahi ki te pūnaha romahā. I roto i te take tuatahi, whakaurua te ngongo endotracheal te roto i te mangai, i roto i te tuarua - i roto i te mau irava nasal. I roto i te taatou e rua, kia whakawhanake pōauautanga tika ki te kino okana. Na reira, i mua i te kōwhiri i te ara o te whakahaere o te ngongo, e hiahia ana koe ki te aromatawai i te tūponotanga. Heoi, kia whakamana i intubation ki te mea e tika mō ngā mahi faufaa o te tinana.

Tuhinga hoki whakahaere o te ngongo endotracheal

I roto i te āhua kino whakarato taea airway anake i te whakauru i te ngongo tracheal ki te mangai nasal ranei kōhao. I roto i te nuinga o te wā, e kore e te manawanui ite mamae i roto i te tukanga. Mai te iwi e rapu whakaora, he maha mauri. He nga tohu e whai ake nei mō te tracheal intubation:

1. Me hoki ventilation aunoa. ventilation Mechanical whakamana te kore anake i te wā o te āwhina whawhati tata, engari ano hoki i roto i te ICU. A amo i tenei tikanga e taea kahore tracheal intubation.
2. Ko te hiahia mo te rehunga whānui. I roto i tenei take rawa, e hiahiatia ana te whakataki o te ngongo whāhauhau te. I muri i te katoa, i roto i rehunga whānui te whakakahore nga uaua katoa, tae atu i te uaua romahā.
3. Whakatinana o tracheal me lavage arahau. tohua ana tēnei tukanga i roto i te tūroro nei haere hūpē, tirotiro puku ki te airway.
4. Whakapai ake o te utu hau i waenganui i nga pūkahukahu me te taiao.

Kei te whakapono te reira e whakaurua te ngongo endotracheal e te mangai (orotracheal) e whakaaturia i roto i ngā āhuatanga tino nanakia. I roto ia ratou - mutu manawa me te mahi ngakau (mate haumanu) , me te pōroa o tetahi takenga. He whakataki Nasotracheal iti pōauautanga me te whakaaro ake whaiaroaro. Otiia, mo te ārai o te kore romahā whakapeka, maha whakamōhio tākuta he ngongo i roto i te mangai.

Utauta mō te tracheal intubation

I roto i te tiaki tino mātanga kia tonu kia he huinga mo tracheal intubation. Kei te rongoa te reira i roto i te pouaka motuhake ki taputapu hangaia mō te ventilation pūkahukahu. Whakatakotoria he hoki intubation kawea i roto o te kōwae tiaki kaha ki te tika. E pā ana tēnei i roto i te wā i reira te wawe tohu te manawanui ventilation aunoa. E wātea ana mea Medical i roto i te huinga:

1. Laryngoscope. māngai tēnei pūrere e rua wāhanga matua - te mata me te kakau. mahi te reira i te whakawhetai ki te pākahiko pūhiko ranei. E whakaurua ratou ki roto ki te kakau o te laryngoscope. haere mai nga matatahi i roto i ngā rahi me ngā āhua (kōpiko me te tika). Kei te whakaurua tenei wahi ki te kōhao-waha. I te mutunga o te rau kua he marama e te turama i te Airways. tei rahi Tīpakonga laryngoscope i runga i tau o te manawanui, huru o te kōhao-waha.
2. momo Various o korere endotracheal. Ko te kete ngā taputapu mō te intubation o e rua ngā pakeke me ngā tamariki. rerekē ratou i roto i te rahi, i te aroaro ngaro ranei o te soté, diameter waho, roa me te maha o lumens. Ki te taea te kawea enei ngongo i rua intubation te taheraa, me te nasotracheal. Nuinga o ngā wā whakamahi wahine rahi tau mahani 7-8, tangata - 8-10. Ki te tirohanga ki te intubation o tūroro pakeke rapua e ngongo endotracheal ki te soté. Ki te whakarite i te patency o nga Airways o ngā tamariki - i waho reira.
3. Kaiwhakahaere endotracheal ngongo ki te hoatu i te piko e hiahiatia ana.
4. Kuku ānau.
5. taero Nebulizer mō te rehunga.

Ahakoa te meka e i roto i te mahi e kore reira e whakamahi katoa o te huinga o taputapu, he tika to ratou aroaro i roto i te ki tonu i.

I roto i ētahi wā, he Kāore te whakataki o te ngongo endotracheal?

Ahakoa e pā ana te intubation ki nga ngā tukanga e tika ana, te mea he maha o contraindications. Ko ētahi o ēnei: kaki whara, te pukupuku i roto i nga kōwhao waha, me te nasal, pupuhi o nga Airways. I roto i enei take, e kore te ngongo whakataki kawea painga engari whai wāhi anake ki te whanaketanga o pōauautanga nui (āputa kiko, filosilivá whara aho). Na reira, i mua i puta ki te intubation, he mea e tika ana ki te titiro i te mangai, me te ihu, e whakarongo ki te āhua o te tuaiwi o runga.

I tua atu, i te whakataki o te ngongo endotracheal kia uaua i raro i etahi tikanga, contraindications kore. I roto ia ratou: he arero nui, he kaki poto, ranei kauae, te mōmona, tino kohuki niho mua, he mangai kuiti, me kōhikohiko pukorokoro. I roto i te aroaro o taua āhuatanga i roto i te manawanui, kia kia whakamana intubation ki te tūpato. I roto i enei take, kua hoatu hiahia ki te whakataki o te ngongo nasotracheal. E tika ana kia 1-2 rahi iti.

Technique o intubation

whakamana intubation Orotracheal te rite e whai ake nei:

1. Manawanui e whakanohoia ki runga ki te mata pakeke, ka whiua hoki tona matenga, he iti, me te pana i te kauae raro mua. Ka rite ki te hua, te incisors runga he airway runga i te waka rererangi taua. Ki te taea, kua whakanohoia te reira i raro i te pukapuka kaki.
2. Ki te tika, pure na roto i te mangai vomitus, clots paru.
3. E tomo te mata laryngoscope (i runga i te matau). He mea nui e kore e ki te pa ki te mucosa o te mangai me niho.
4. Na, whakaurua te ngongo endotracheal te. haere te reira i te mangai, me te korokoro. I te taumata o te aho waiata, kia āta unu i te ngongo i waenganui ia ratou i roto i te kōhao o te pukorokoro.
5. nekehia atu Laryngoscope te.
6. Pamû i te soté mo whakatika i te ngongo endotracheal.

whakamana intubation Nasotracheal te i nui te taua. Rerekētanga Ko te taumira o te ngongo, me tona whakataki ki te kōhao nasal. I roto i tenei take, e kore e whakamahia te laryngoscope.

Me pēhea te ki te kawe i te ventilation o pūkahukahu tamariki?

He wā i reira he tika tracheal intubation ki te kawe i nga tamariki. Nuinga o ngā wā, he mea e tika ana mō te kukune haukotia hohonu. Hoki kia tika intubation i roto i te wā fā'ele'i i roto i te kimi hē o te pūnaha romahā me te Cardiovascular. I roto i te wā e rua, te hiahiatia ventilation aunoa. Tuhinga hoki intubation i roto i nga tau teina, me te matua o te tamarikitanga ko te taua rite hoki ngā pakeke. I roto ia ratou he: kore romahā whakapeka, pōroa, whakahaere rehunga whānui.

He aha te mea te āwhata o te hohonu o te intubation?

Ko te hohonu ki nei me te tomo koutou te ngongo endotracheal, tei runga i tona rahi me te taimaha o te tamaiti. Ki te mahi i tenei, te whakamahi i te tauine motuhake. Ko reira hāngai ki ngā pēpi taimi halá, me te hou. Ki te taimaha o te 1 tamaiti kg ki te whakamahi i te rahi 2.5 endotracheal ngongo. whanganga tōna hōhonu te i whakahaere o nga ngutu, me te ko te 6-7 cm. taimaha ki 2 kg whakamahia rahi ngongo rite ki te 3. Body kia kaua e neke atu i te 8 cm te hōhonu i werohia. Ki te ata whakaaro te tamaiti i waenganui i 2 me 4 kg te tono rahi tau mahani № 3 5. Te hohonu i roto i tenei take, ko te i 9 ki te 10 cm. Hoki whanau hou me kohungahunga, ko tona taimaha neke atu i te 4 kg, te whakamahi i te rahi ngongo 4. Ko te hohonu o te whakataki - 11 cm.

He aha e taea e pōauautanga i muri i tracheal intubation?

Kia mahara te reira e te whakataki o te endotracheal ngongo pōauautanga kino pērā i kino ki te membrane mucous o nga whekau. Na reira, me whakahaere tenei whawhe i te mātanga mātanga. Ko te kōwae tiaki kaha, i mua i te tīmata intubation, whakamana rehunga te. Ko te pōauautanga tino noa ngā: kino ki nga niho, te mucosa o te pharynx, te pū kai tomo te ngongo. Hei karo i tēnei, ko reira tika ki āta aroturuki huru o te manawanui.

Whakaurunga o te ngongo endotracheal: whakaaro tohunga

Technique o intubation he katoa tākuta. Otiia, he reira pai ki te mahi i tenei intensivists whawhe me toketā fakamohé. E ai ki a ratou, kahore whakangungu motuhake, me i te ngaro o ngā āhuatanga horomata, e kore e taea hoki tracheal intubation. I muri i te katoa, kia tina heke nga pōauautanga o tenei tukanga. Otiia, ki te whakarato āwhina tuatahi mō ngā take hauora takoto te tākuta o tetahi motuhake.