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AIRWAY MANAGEMENT IN EMERGENCIES - PART 9

Thông thường, một cái nhìn của notch chỉ interarytenoid hay sụn sau thu được trong quá trình laryngoscopy trong sự hiện diện của MILNS. Que thông có thể được thông qua ở trên notch, và ống nội khí quản tiên tiến trên các que thông. | CENTRAL NERVOUS SYSTEM EMERGENCIES 241 Very often a view of only the interarytenoid notch or posterior cartilages is obtained during laryngoscopy in the presence of MILNS. The bougie can be passed above the notch and the endotracheal tube advanced over the bougie. A change to a straight or levering tip blade can be considered if the initial best look laryngoscopy fails.5 57 Following intubation tube position should be objectively confirmed cricoid pressure released and the cervical collar replaced. The blood pressure should be rechecked and additional fluid and vasopressor given if low. However if the blood pressure is intact or once it recovers a head-up reverse Trendelenberg position should be resumed or considered to promote venous drainage. The endotracheal tube ETT should be affixed to the patient although tightly encircling ties around the neck should be avoided. The clinician should ensure that the patient is not being inadvertently hyperventilated this is best accomplished with quantitative end tidal CO2 monitoring or the judicious utilization of blood gases. SUMMARY The patient with known or suspected CNS injury must be treated with particular attention to maintenance of cerebral perfusion pressure and the avoidance of hypoxemia. Manual in-line stabilization should be maintained after removal of the cervical collar and extra preparations should be made for an anticipated difficult laryngoscopy. REFERENCES 1. Thurman DJ Alverson C Dunn KA et al. Traumatic brain injury in the United States a public health perspective. J Head Trauma Rehabil. 1999 14 6 602-615. 2. Langlois JA Rutland-Brown W Thomas KE. Traumatic Brain Injury in the United States Emergency Department Visits Hospitalizations and Deaths. Atlanta GA Centers for Diseae Control and Prevention National Center for Injury Prevention and Control 2004. 3. Balestreri M Czosnyka M Hutchinson P et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after .