快速程序诱导.ppt

RSI快速程序气管插管 What are the difference between the RSI and traditional rapid induction RSI? 快速程序诱导插管和传统的快速诱导插管有何区别？ Differences are区 别 An organized approach to endotracheal intubation 　系列的气管内插管的方法 Rapidly induce anesthesia facilitate intubations 　快速诱导麻醉便于插管 No positive pressure ventilation 　没有正压通气 Cricoid pressure to protect airway 　环状软骨按压保护气道 Avoid aspiration in “full-stomach” patients 　“饱胃”病人避免误吸 ACEP, 2000 谢 谢 ！ * VS point 2 could read : rapidly create the ideal intubating conditions * Dronen,S.C., 1999 * VS point 2 could read : rapidly create the ideal intubating conditions 快速程序诱导 Rapid Sequence Induction 病 例（Case Insert） A 38 year old female，女性 38岁 Peritonitis for 3 days 腹膜炎3天 Shocked with: 休克： 1. T: 38 o C 体温：38℃ 2. Pulse:120/minute 脉搏：120次/分 3. BP: 70 mmHg systolic 血压：收缩压 70mmHg 4. Poor nail bed capillary return 末？回流差 5. Respiratory rate 呼吸：30次/分 6. Confused 烦躁 7. Urinary: 20mL of concentrated urine 尿量: 20mL 的浓缩尿 The surgeon wants to operate immediately 外科医生准备尽快手术 麻醉方式？Anesthesia ? regional anesthesia? 硬膜外麻醉？ General anesthesia?全身麻醉？ 诱 导Induction 芬太尼 Fentanyl 异丙酚 Propofol 罗库溴胺 Rocuronium 快速诱导插管 RSI 快速顺序插管Rapid Sequence Intubation 1. INDUCTION 2. PRESSURE 3. PARALYSIS 插 INTUBATION管 病 例（Cases） 成年病人（Adult patient） 小孩（Child） 全身麻醉的主要并发症Main complications of GA ? Regurgitation 返流 ? Vomiting 呕吐 ? Aspiration 误吸 ? Desaturation, ? Laryngospasm 喉痉挛, ? Airway obstruction气道梗阻, ? Bronchospasm支气管痉挛, ? Cardiac arrest心跳骤停 快速诱导插管的目的GOAL of RSI 保护气道 Protect airway 便于插管 Facilitate intubations 快速诱导麻醉 Rapidly induce anesthesia ACEP, 2000 History Cricoid cartilage pressure to prevent regurgitation- Sellick1961. First series of ED intubations –Taryle, 1979 First series of intubations using succinylcholine in the ED – Thompson, 1982 American College of Emergency Physicians (ACEP) RSI policy statement(1997):- Reaffirmed, 2000 “phys