tailieunhanh - Trauma Resuscitation - part 3

Kỹ thuật kết hợp với xuất huyết đáng kể từ mạch giãn nở như là kết quả của hypercarbia và tình trạng thiếu oxy. Nếu có chấn thương thanh quản hoặc tụ máu mở rộng trong lĩnh vực hoạt động | 50 TRAUMA RESUSCITATION Figure Surgical cricothryoidotomy devices and tracheal suction to remove blood and secretions etc. The technique is associated with significant haemorrhage from vessels dilated as a result of hypercarbia and hypoxia. If there is laryngeal trauma or an expanding haematoma within the operating field a formal tracheostomy performed by an appropriate expert is the technique of choice. Procedure Figure In the absence of trauma to the cervical spine hyperextend the patient s head. The landmarks of the cricothyroid membrane are identified and if time permits marked. When possible the skin is prepared with antiseptic solution. Infiltrate the skin over the membrane with 1 lignocaine with adrenaline epinephrine 1 100000 to minimize cutaneous bleeding. The operator stabilizes the thyroid cartilage with one hand. A transverse incision 2-3 cm long is made over the membrane. A finger is then inserted into the wound to reassess the membrane s position. The membrane is incised transversely. A channel is created with either the scalpel handle artery forceps or a self-retaining retractor. The assisting nurse may need to maintain this channel if there is vigorous movement of the larynx. A lubricated tracheostomy tube is inserted directed caudally into the trachea. The cuff is inflated and ventilation commenced. Correct position is confirmed by checking for CO2 in expired gas observing chest movement and auscultation. The tube is secured with sutures or tape and any blood or debris aspirated. Complications Surgical damage to any of the adjacent structures. THE MANAGEMENT OF THE AIRWAY AND CERVICAL SPINE CONTROL 51 . LU e b s 11 e s - B s This site is aimed at emergency physicians and orientated to American practice. It does however contain some useful information in the education section. http _ The best .

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