tailieunhanh - Core Topics in Operating Department Practice Anaesthesia and Critical Care – Part 3

bệnh nhân có một thoát vị gián đoạn (một phần của dạ dày đẩy vào ngực thấp hơn thông qua một khiếm khuyết ở cơ hoành dẫn đến một tiềm năng tăng cho dạ dày trào ngược vào thực quản) • bệnh nhân trong giai đoạn cuối của thai kỳ (nơi vị trí của thai nhi gây ra trào ngược dạ dày) • bệnh nhân đã bị chấn thương sau chấn thương (chấn thương chấn thương làm chậm tiêu hóa và làm rỗng dạ dày) . | The use of cricoid pressure during anaesthesia 31 the risk of aspiration even further include for example patients who have a hiatus hernia where part of the stomach pushes up into the lower chest through a defect in the diaphragm leading to an increased potential for gastric reflux into the oesophagus patients in the late stages of pregnancy where the position of the foetus causes gastric reflux patients who have suffered traumatic injury traumatic injury slows digestion and stomach emptying cases of severe head injury unconscious patients have no natural ability to protect their airway from regurgitated stomach contents patients who are intoxicated with drug or alcohol use deeply unconscious patients through misuse of alcohol and drugs are unable to protect their own airway naturally from regurgitated stomach contents any other clinical situation where gastric emptying is delayed. There are also emergency situations where the use of cricoid pressure is not advised including for example active vomiting unstable cervical spine injury and cricotracheal injury. Cricoid pressure is a part of an anaesthetic technique known as Rapid Sequence Induction RSI . RSI is often carried out where gastric emptying is delayed. Conditions such as these present difficulties for anaesthetists and healthcare providers and wherever possible alternatives to general anaesthesia may be sought. Applying cricoid pressure When applying cricoid pressure the cricoid cartilage the only complete ring of cartilage in the trachea is manually pushed back against the cervical spine at the level of the C5 C6 vertebrae to occlude the oesophagus which lies directly beneath the trachea. All other cartilage rings contained in the trachea are made up of semicircles and are therefore not suitable for use in this technique. The manoeuvre is achieved by using the thumb and index finger usually of the right hand to compress the cricoid cartilage Figure . The right hand is normally used because of the .