要是这样就是对自己不仁道了。作者: 朱晓军 时间: 2010-3-27 18:27
手术室外插管应该带齐全套喉镜片和气管导管，这样有选择机会，否则将会因插管不成功被家属发现投诉麻烦大了。有意识的病人要签字，可能要用全麻药或表麻。插管时要家属回避，防止误解。作者: 逸阳绝风 时间: 2010-3-27 20:37
插管准备（估计插管难度，观察有无松动牙齿，最好能跟家属沟通插管的并发症）沟通的同时要麻醉插管签字。我们一般没请家属回避，至于有战友说插管差不进去不好意思重插，这就是你的不对了，没插进去重插是必须的，这时候救命最要紧啊！！！作者: dragon2004212 时间: 2010-3-27 22:53
创伤患者急症气管插管的成功，一个大型成年创伤转诊中心的十年经验（Anesthesia & Analgesia
）
The Success of Emergency Endotracheal Intubation in Trauma Patients: A 10-Year Experience at a Major Adult Trauma Referral Center
Christopher T. Stephens, MD,
Stephanie Kahntroff, MD and
Richard P. Dutton, MD, MBA
From the Division of Trauma Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
Address correspondence and reprint requests to Richard P. Dutton, MD, MBA, Division of Trauma Anesthesiology, University of Maryland Medical System, 22 South Greene St., Baltimore, MD 21201. Address e-mail to rdutton{at}anes.umm.edu. Abstract
[b]BACKGROUND: Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission.
METHODS:[/b] We examined Trauma Registry, quality management, and billing system records from July 1996 to June 2006 to determine the number of patients requiring intubation within 1 h of hospital arrival and to estimate the number requiring intubation with the first 24 h. We reviewed the medical record of each patient in either cohort who underwent a surgical airway access procedure (tracheotomy or cricothyrotomy) to determine the presenting characteristics of the patients and the reason they could not be orally or nasally intubated.
RESULTS: All intubation attempts were supervised by an anesthesiologist experienced in trauma patient care. Rapid sequence intubation with direct laryngoscopy was the standard approach throughout the study period. During the first hour after admission, 6088 patients required intubation, of whom 21 (0.3%) received a surgical airway. During the first 24 h, 10 more patients, for a total of 31, received a surgical airway, during approximately 32,000 attempts (0.1%). Unanticipated difficult upper airway anatomy was the leading reason for a surgical airway. Four of the 31 patients died of their injuries but none as the result of failed intubation.
CONCLUSIONS: In the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.（急诊气道处理的高成功率是可能达到的，在此研究中，有效的气道管理的基石是快速有序麻醉诱导，谨慎选择辅助设备，入院时即有有经验的麻醉医师在场。）作者: brightwith 时间: 2010-3-28 07:24 本帖最后由 brightwith 于 2010-3-28 07:37 编辑
