tailieunhanh - AIRWAY MANAGEMENT IN EMERGENCIES - PART 4

Thông thường một chút "pop" sẽ được cảm thấy như nó tiến bộ thông qua việc mở thuộc về cửa hầu, sau đó là nâng cao hơn nữa. Hai hiện tượng xúc giác sau đó có thể được tìm kiếm để xác nhận rằng vị trí đặt nội khí quản và thực quản không, đã đạt được | TRACHEAL INTUBATION BY DIRECT LARYNGOSCOPY 81 Figure 5-29. The distal coudé tip angled at 35 of various brands of single- and multiuse bougie. and holding it at around the 20-cm mark it is gently placed via the corner of the mouth and advanced towards the midline beneath the epiglottis seeking to keep its tip in contact with the undersurface of the epiglottis Figs. 5-30 and 5-31 . Often a slight pop will be felt as it advances through the glottic opening whereupon it is further advanced. Two tactile phenomena can then be sought to confirm that endotracheal and not esophageal placement has been achieved. Firstly once the bougie tip has passed through the cords and is being advanced down the trachea a fine click-click sensation may often 90 of the time 38 be appreciated as the tip runs over the tracheal cartilaginous rings. Experience suggests however that this sensation can vary considerably from patient to patient from nothing more than a feeling of fine sandpaper in some to a fairly overt click-click in others. No such sensation is generally obtained if advancing down the esophagus. The second sign suggesting tracheal placement of the bougie is that with continued advancement resistance will be encountered as it holds up in a small distal airway. This holdup will occur at about the 30 cm mark plus or minus 5 cm in the adult Figure 5-30. Placement of the angled tip of the bougie under the epiglottis into the trachea. 82 CHAPTER 5 Figure 5-31. The tip of the bougie is placed blindly beneath the epiglottis keeping its tip midline and anterior. Fig. 5-32 and is a consistent finding if the bougie is correctly placed in the If the bougie can still be advanced at 40 cm or more it is most likely in esophagus. Bougie hold-up if sought should be done gently in order to avoid trauma to the lower bronchi and should probably be avoided if the clinician already suspects successful tracheal access based on tracheal clicks. Softer third and fourth signs of successful .