Endotracheal şarkı (endotracheal Tube): styles, nui like 'ole, i manao ai. E kau no ka intubation

Eia naʻe, mai kaʻano o nā palapū, a illnesses i ole hemolele. I loa hoopii, e pono koke kōkua i kekahi kanaka i loko o ka pilikia. No ka mea, ina ua poino, ola-na olelo hooweliweli au. O nā mea mamao aku ana e like me airway iaʻi, cardiac hopu, kŰia, coma. Ka iapaau ana o kēia mau pathologies e e mālama 'ia i loko o ka mālama nui malama pa alima. Eia naʻe, pono e lawe koke koke 'ana ma hope o ka loiloi' ana o ka hoomanawanui, oa ma ke kahua o ka pilikia. Ma ke kaʻa, "ambulance" ua kau no ka tracheal intubation, he defibrillator, Ambu eke. Kēia mau 'inikua manaʻo e koi wale nō i loko o loa hihia, i ka wa a kekahi kanaka hiki ole hanu kū kaʻawale.

He aha ka ke endotracheal Tube?

Maoli ai, ka tracheal intubation pili i kaʻawaʻawa loa kaʻina hana. Akā, hoʻowahāwahā i ka hana a he leo, ia mea e pono ai ola kumu. E widen ka Hawaiian Airlines, a hoʻopaʻa i ka 'ae' ana o o oxygen i na maʻiʻaʻai, ke endotracheal şarkı ua hookomoia. E e hiki ke intubate i ke kauka o kekahi specialization. No Pono ka keia ke akamai a me ka resuscitators anaesthesiologists, kauka ambulance. Me ka hoike ana o ka endotracheal şarkı akemāmā hoʻokomo ea i maʻamau hou, hoʻowahāwahā i kaʻino i ka Air. Eia hou kekahi, ma ka hoʻohana 'ana i kēiaʻano papa hana hiki e lawe maiʻimi hoʻopunipuni ka oxygen lako. He nui ke ano o ka endotracheal paipu (20). Ka mea, oko a ma ka nui a me ke alo o ka houʻano papa hana (pūliki koa). A pau i ka hana no ka intubation, ua māheleʻia i loko o 2 ano: irrigated a nasotracheal Tube. Ka mea, oko ma na aoao o ka anal a hiki i ka ÷ naehana hanu nenoaiu. Ma ka hihia mua, ka endotracheal şarkı ua hookomoia ma ka waha, ma ka lua o ka - ma ka nasal ala. Ma nā nā kinolau, complications i hoʻomōhala pono i ka hui, kēia pōʻino. No laila, ma mua koho i ke ala o ka hooponopono ana o ka Tube, e pono e Loiloi i ka ka pilikia. Eia naʻe, E hanaʻia nō ia intubation ina ia mea e pono ai ke kino i ka nui i hana '.

Nāʻikepili no ka hooponopono ana i ka endotracheal Tube

I loa Hawaii ka hoʻolako 'airway hiki wale ma ka tracheal şarkı i hoʻolaunaʻia ma loko o ka waha a me ka nasal lua. Ma ka hapanui o na hihia, ka hoʻomanawanui 'aʻole ole ma ke kaʻina hana haha eha. No ka poʻe e noi aku resuscitation, ua pinepine unconscious. Aia nō i ke kēia nāʻikepili no tracheal intubation:

1. Mau hea hana no ka me mechanical hoʻokomo ea. Mechanical hoʻokomo ea ua hana ia ma ke kahua o ka pilikia ke kokua ole wale, akā, i loko o ka ICU. Lawe ana mai i kēia ke kaʻina hana no ka hiki ole me tracheal intubation.
2. Ka nele no ka mau anesthesia. Ma keia hihia nui, i ka hoike o pneumatic Tube ua koi 'ia. Ma hope o nā mea a pau, iloko o mau anesthesia relaxes na nāʻiʻo a pau, a me ka ÷ naehana hanu nāʻiʻo.
3. Manaʻo o ke tracheal a me bronchial lavage. Kēia ke kaʻina hana no ka hōʻike i nā mea maʻi nona e hele mucus,'ōpū Contents i loko o ka airway.
4. Hou ana o ke kinoea launa like ma waena o nā maʻiʻaʻai a me ke kaiapuni.

Ua Ua manaoio aku i ka endotracheal şarkı ua hoʻolauna ma ka waha (orotracheal) ua hoike mai ia ma kaumaha loa ana. Iwaena o lakou - paʻa hanu a me ka naau aayoaeuiinoe (lapaʻau make) , a me ka coma o kekahi kumu. Nasotracheal hoike, he poʻeʻuʻuku complications, a ua manaoia hou physiological. Aka hoi, no ka mea, o ka Kāohiʻana o ka huʻi naehana hanu ole, kauka pinepine mai i ka Tube ma ka waha.

Mea Hana 'no ka tracheal intubation

I ka mālama nui mālama hoʻomalu E mau e ka lākou no ka tracheal intubation. Ua Ua waiho ia ma ka kūikawā pahu me na mea paahana papahana no pulmonary hoʻokomo ea. E kau no ka intubation lawe mai o ka mālama nui malama pa alima ina e pono ai. He pili i ka hihia ma ka hoʻomanawanui ua urgently hōʻike me mechanical hoʻokomo ea. Lapaʻau mea hana i loaʻa i loko o ka lākou:

1. Laryngoscope. Keia mea ua poe e mau ka papa kuhikuhiE eiiiiiaiou - ka maka, a me ka kumu. Ua hana aku la i kekahi o na pu ki a iuo aaoa?. Ka mea, e hoʻokomo i loko o ka 'au o ka laryngoscope. Ke kōmi 'ana e hele mai i loko o kekahi mau nui like' ole a me nā kinona (uma a me ka pololei). Keia hapa Ua hookomoia i loko o ku una ha o ka lua. I ka pau ana o ka maka i ka malamalama i illuminates ka Air. Koho laryngoscope nui hilinaʻi nui ma luna o ke ahonui o ka makahiki, ano o ku una ha i ka lua.
2. Mai Ke Kula Kaiapuni 'ano o endotracheal paipu. Ke kini puʻe wale nā mea paahana no ka intubation o nā mākua a me nā keiki. Ka mea, oko ka nui, i ke alo a kaawale o ka cuff, mawaho anawaena, lōʻihi a me ka helu o nā lumens. Me kēia mau paipu hiki ke lawe mai nā irrigated a me ka nasotracheal intubation. Loa pinepine na wahine hoʻohana leki uea nui 7-8, na kanaka - 8-10. Me ka manao e intubation o ka makua e hoomanawanui i koi endotracheal şarkı me ka cuff. E hōʻoia i ka patency o ka Hawaiian Airlines o nā keiki - me ia.
3. Alakaʻi mele endotracheal şarkı e hai aku i ka makemake hoʻohei.
4. Hālawa forceps.
5. Nebulizer ai 'no ka anesthesia.

I loko nō o ka mea i loko o ka hana pono ia, aole ia e hana a pau o ka lākou o ka mea paahana, kā lākou alo mea pono i ka piha.

Ma kekahi mau hihia, i ka hoike o ka endotracheal şarkı mea unacceptable?

ʻOiai ka intubation pili ia i ka mea e pono ai ke kaʻina hana, ka mea, i ka helu ana o contraindications. Mau nā:'ā'ī poino, hikoko ma ku una, a nasal na cavities, haanou ana o ka Air. Ma kēia hihia, me ka hoʻokomo 'ia' şarkı i lawe pono akā wale ka poʻea pau i ka ulu ana o ka loa complications (nahā i'aʻaʻa, spinal kaula eha). No laila, ma mua lede i ka intubation, ia mea pono, e ninaninau i ka waha a me ka ihu, e lohe i ka moku'āina o ke keena spine.

Eia hou, i ka hoike o ka endotracheal şarkı i e paʻakikī ma lalo o kekahi mau rula, ai 'contraindications. I waena o lākou: olelo he nui, he pōkole'ā'ī, a me ka iwia, obesity, me ka nui loa nei iluna ke alo mau niho, he hāiki waha a me ka trachea anomalies. Ma ke alo o ia mau hiʻona i loko o ka hoomanawanui, intubation E hanaʻia nō ia me ka mālama nui. Ma kēia hihia, ua haawiia mai i ka hoike o nasotracheal Tube koho. Ka mea, e ia 1-2 nui uuku.

'Ana i kūpono o ka intubation

ua hana Orotracheal intubation like penei:

1. Hoomanawanui ua kau ma luna o ka paakiki luna, E hoolei mai ia i kona poʻo i ka uuku, a pahu aku ai i ka lalo iwi ā mua. E like me ka hopena, i ka luna incisors i airway ma luna o ka mea hookahi pelane. Inā hiki, e ua waiho ma lalo o ka'ā'ī'ōwili.
2. Inā pono, huikalaʻia ma ka waha vomitus, clots lepo.
3. Kikokiko i ka laryngoscope maka (ma ka akau). Ia mea nui,ʻaʻole e hoʻopā i ka mucosa o ka waha a me ka niho.
4. A laila, i ka endotracheal şarkı ua hookomoia. Ua ae ka waha a me ka puʻu. Ma ka nui o na kaula vocal, ka Tube E e akahele i unuhiʻia ma waena o ia mau mea i loko o ka lua o ka trachea.
5. Laryngoscope ua wehe.
6. Inflating he cuff no ka hoʻopunipuni ka endotracheal Tube.

Nasotracheal intubation ua hana ma ka nui o ka ia. Oko i ka hoʻonā 'ana o ka Tube a me kona pōkole i loko o ka nasal lua. Ma keia hihia, ke laryngoscope ua ole i hoʻohana.

Pehea e lawe mai i ka hoʻokomo ea o ia maʻiʻaʻai keiki?

Aia nā hihia kahi tracheal intubation mea pono, e lawe mai i nā keiki. Loa pinepine, ia mea pono no ka hohonu'ō'ū fetus. No hoi intubation i e pono ai i loko o ka neonatal wā i loko o kaʻimiʻana mā o ka ÷ naehana hanu a me ka mea'ōnaehana mānowai koko kahua. Ma nā hihia a pau, ke koi 'ia me mechanical hoʻokomo ea. Nāʻikepili no ka intubation i loko o ka Junior a me ka ili makahiki o ka noho 'ana kamaliʻi i ka mea like me ia no nā mākua. I waena o ia mea: huʻi naehana hanu ole, coma, e mālama nei mau anesthesia.

He aha ka i ka pālākiō o ka hohonu o ka intubation?

Ka hohonu i a oe e komo i ka endotracheal şarkı, hilinaʻi nui ma luna o kona nui a me ke kaumaha o ke keiki. E hana i kēia, e hana i ka hana me ka unahiʻole. He pili i ka premature a me keiki keiki. Me ke kaumaha o ka 1 kg keiki e hoʻohana i ka nui 2,5 endotracheal Tube. Kona hohonu, ua ana mai ka hooponopono ana o na lehelehe, a he 6-7 knm. Kino ke kaupaonaʻana no 2 kg hoʻohana şarkı nui like i ka 3. Na ka pahu kui ka hohonu E e ole aku ma mua o 8 knm, Inā i ke keiki kaupaona ma waena o 2 a me 4 kg ua noi leki uea nui № 3 5. Ka hohonu i loko o keia hihia mea mai ka 9 a hiki i 10 knm. No nā pēpē i a me nā kamaliʻi, kona kaumaha oi aku mamua o 4 kg, ka hoʻohana 'ana i ka Tube 4 nui. Ka hohonu o ka hoʻokomo 'ia' - 11 knm.

He aha hiki e complications ma hope o tracheal intubation?

Ua hoʻomanaʻoʻia ai ia i ka hoike o ka endotracheal şarkı pilikia complication e like me poho i ka mucousʻili lahilahi o ka na nā loko. No laila, pono e mālama 'ia ma ka hoao ana i ka hoʻomalu keia manipulation. Ke mālama nui malama pa alima, ma mua e hoʻomaka ana intubation, anesthesia ua hana. Ka loa, he pono ole complications ioiinyony: pohō i nā niho, i ka mucosa o ka pharynx, ka esophagus komo i ka Tube. E pale ia, ia mea pono e akahele kanaka hoʻoponopono i ka hoʻomanawanui ka kulana.

Hookomo ana i ka endotracheal şarkı: akamai manao

'Ana i kūpono o ka intubation mai na kauka. Aka hoi, ia mea maikai, e hana i kēia manipulation intensivists a me anesthesiologists. E like me ia ia lakou, me ka kūikawā aʻo, a ma ka wa e kaawale aku o sterile rula, he mea hiki ole no ka tracheal intubation. Ma hope o nā mea a pau, na complications o kēia kaʻina hana i e irreversible. Aka, e hoolako mua kōkua no ka ola kumu koiia ke kauka o kekahi hana kūikawā.