tailieunhanh - AIRWAY MANAGEMENT IN EMERGENCIES - PART 10

Một kỹ thuật đặt nội khí quản thay thế cần được xem xét, nếu "cái nhìn tốt nhất" laryngoscopy và sử dụng một thuốc hỗ trợ như một que thông hoặc cáp quang dao găm nhỏ đã thất bại. Một sự thay đổi để một lưỡi dao (ví dụ, trực tiếp hoặc levering đầu) dài hơn, hoặc khác nhau hình có thể được sử dụng ở những bệnh nhân được lựa chọn. | THE VERY YOUNG AND THE VERY OLD PATIENT 273 An alternative intubation technique should be considered if best look laryngoscopy and the use of an adjunct such as a bougie or fiberoptic stylet has failed. A change to a longer or differently shaped . straight or levering tip blade may be of use in selected patients. Alternative device use should consider operator experience and the likelihood of success. It may be more appropriate to temporize by proceeding to a rescue EGD in lieu of using an unfamiliar alternative technique when best look laryngoscopy has failed after two or three attempts. D. Postintubation care in the elderly Successful airway management should not detract from the recognition that even with a secured airway the elderly patient remains fragile and prone to cerebrovascular and cardiac catastrophe. Airway management is only the first step in providing the critically ill elderly patient an opportunity to return to meaningful life. The aging heart brain and kidney need optimal oxygenation and perfusion if they are to survive. SUMMARY Most aspects of airway management at the extremes of life are similar to those needed for the older child and non-elderly adult. However the clinician must be cognizant of the anatomic and physiologic differences which may be encountered with the resultant need to prepare for difficulty and adjust drug dosing appropriately. REFERENCES 1. Patel R Lenczyk M Hannallah RS et al. Age and the onset of desaturation in apnoeic children. Can. J. Anaesth. 1994 41 9 771-774. 2. Morrison JE Jr. Collier E Friesen RH et al. Preoxygenation before laryngoscopy in children how long is enough Paediatr. Anaesth. 1998 8 4 293-298. 3. Meretoja OA Bissonnette B Dalens B. Muscle relaxants in Children in Pediatric Anesthesia Principles and Practice. New York McGraw-Hill 2002. 4. Zelicof-Paul A Smith-Lockridge A Schnadower D et al. Controversies in rapid sequence intubation in children. Curr. Opin. Pediatr. 2005 17 3 355-362. 5. 2005 AHA .