tailieunhanh - AIRWAY MANAGEMENT IN EMERGENCIES - PART 5

Nếu một Cormack lớp 3 (tiểu thiệt) xem vẫn còn mặc dù laryngoscopy "nhìn", trong khi việc duy trì với laryngoscopy đang diễn ra, các đầu lắp ráp phạm vi / ống được đặt dưới tầm nhìn trực tiếp, gần, nhưng hơi thấp hơn và tránh xa đầu tiểu thiệt ("tip-to-tip," Hình 6-25 A) 0,39 vị trí này có thể được giữ lại bằng cách nghỉ ngơi | ALTERNATIVE INTUBATION TECHNIQUES 113 with direct laryngoscopy. If a Cormack Grade 3 epiglottis only view persists despite best look laryngoscopy while retaining that view with ongoing laryngoscopy the tip of the scope tube assembly is placed under direct vision close to but slightly below and away from the tip of the epiglottis tip-to-tip Fig. 6-25 A .39 This position can be retained by resting the tube gently against the upper teeth while the clinician then transfers from direct vision to indirect fiberoptic visualization through the scope eyepiece. Once the glottic opening has been identified the ETT scope assembly is advanced through the cords. During this advancement to conform to the axis of the trachea the proximal eyepiece end of the scope will have to be gradually rotated downward. After the trachea has been accessed the laryngoscope can be removed. While visualization through the eyepiece is maintained the left hand can now be used to slide the ETT away from the tube holder housing and further on down the trachea. Alter natively the laryngoscope can be maintained in position while a briefed assistant advances the ETT off the stylet. Once the ETT is placed the fiberoptic stylet is withdrawn from the tube by forward rotation. After cuff inflation the position of the ETT is confirmed with a second objective method. In the very rare situation in which a Cormack Grade 4 no identifiable structures view is obtained at direct laryngoscopy the fiberoptic stylet tube assembly can be advanced along the laryngoscope blade using the blade as a guide until the epiglottis is visualized through the eyepiece. Appropriate maneuvers are then performed to advance the tube beneath the epiglottis and through the cords. To attain and maintain skills with the device some clinicians have espoused the use of optical stylets with every intubation attempt39 if the cords are easily visualized with direct laryngoscopy the tube can be advanced in regular fashion with the fiberoptic .