tailieunhanh - AIRWAY MANAGEMENT IN EMERGENCIES - PART 6

Các biến chứng sớm của cricothyrotomy bao gồm chảy máu, đặt ống không chính xác hoặc không thành công, gãy xương sụn cricoid, tắc nghẽn và tràn khí dưới da. Hiếm khi, thanh quản, thực quản, hoặc chấn thương trung thất có thể xảy ra. | RESCUE OXYGENATION 145 Figure 7-26. With thumb and long finger stabilizing the thyroid cartilage the index finger palpates the cricothyroid membrane. position confirmed in the usual fashion. A Shiley tracheostomy tube will have to have its inner dilator removed and replaced with the inner cannula. Once tracheal placement has been confirmed the tracheal hook is removed and the cannula or ETT is secured. Figure 7-28. The index finger re-palpates the cricothyroid membrane within the wound. Early complications of cricothyrotomy include bleeding incorrect or unsuccessful tube placement cricoid cartilage fracture obstruction and subcutaneous emphysema. Rarely laryngeal esophageal or mediastinal injury can occur. Pneumothorax pneumomediastinum and aspiration are also infrequent complications. After the situation has stabilized a cricothyrotomy should be replaced either by intubation from above or by conversion to a formal tracheostomy. This will help minimize Figure 7-27. A 3-cm vertical incision is made over the cricothyroid membrane. Figure 7-29. A horizontal incision is then made in the cricothyroid membrane. 146 CHAPTER 7 Figure 7-32. A 4 tracheostomy tube is placed between the arms of the Trousseau dilator into the cricothyrotomy opening. Figure 7-30. A tracheal hook picks up and stabilizes the inferior border of the thyroid cartilage and is passed off to an assistant. vocal cord morbidity or the occurrence of subglottic stenosis at the level of the cricoid ring. PEDIATRIC OPTIONS FOR RESCUE OXYGENATION At the outset it must be said that a failed oxygenation situation is very unusual in the pediatric population due in no small measure to the fact that this population is almost always easy to bagmask ventilate. However as in the adult if intu bation has failed and difficulty is encountered in maintaining oxygen saturation with BMV rescue oxygenation can be achieved with both extra-glottic devices as well as via transtracheal access. Extraglottic Device Use in the .