I loko o ka lāʻau lapaʻau, ʻo ka 'intubation' e pili ana i kahi ʻenehana e hiki ai ke hoʻokomo i kahi paipu i ke alaloa - ʻoi aku ka pololei i loko o ka trachea - ma o nā kaula leo o ka mea maʻi me ke kumu nui e ʻae i ka mea hiki ʻole ke hanu kūʻokoʻa e hanu.

ʻO ke ala maʻamau o ka intubation ʻo ka 'endotracheal' intubation, hiki ke hana

• ootracheally: komo ka paipu ma ka waha o ka mea maʻi (ke ʻano maʻamau);
• rhinotracheally: komo ka paipu ma ka ihu o ka mea maʻi (ke ala maʻamau).

Intubation: i ka manawa hea e hoʻohana ʻia ai?

ʻO ke kumu nui o nā ʻano intubation a pau, ʻo ia ka ʻae ʻana i ka hanu o ke kanaka, no nā kumu like ʻole, hiki ʻole ke hanu kūʻokoʻa, kahi e hoʻopilikia ai i ke ola o ka mea maʻi.

ʻO ka pahuhopu ʻē aʻe o ka intubation ʻo ia ka pale ʻana i ke ea mai ka inhalation o nā mea ʻōpū.

Hana ʻia ka intubation i nā kūlana olakino, e like me:

• i nā maʻi coma;
• ma lalo o ka anesthesia āpau;
• i ka bronchoscopy;
• i nā kaʻina hana endoscopic operative e like me ka laser therapy a i ʻole ka hoʻokomo ʻana o kahi stent i loko o ka bronchi;
• i ka ho'ōla hou ʻana i nā maʻi e koi ana i ke kākoʻo hanu (e laʻa i nā hihia o ka maʻi Covid 19 koʻikoʻi);
• i ka lāʻau lapaʻau pilikia, ʻoi aku ka manawa o ka hoʻihoʻi ʻana i ka cardiopulmonary.

Nā mea ʻē aʻe i ka intubation

Aia kekahi mau mea ʻē aʻe i ka intubation, akā ʻoi aku ka nui o ka invasive a ʻoiaʻiʻo ʻaʻole hiki ke pilikia, no ka laʻana.

• tracheotomy: he hana ʻokiʻoki kēia i hoʻohana mau ʻia i nā poʻe maʻi e koi ana i ke kākoʻo hanu lōʻihi; heluhelu hou: Hiki i ka Tracheotomy ke kamaʻilio, ka lōʻihi, nā hopena, ke hana ʻia
• cricothyrotomy: he hana ulia pōpilikia i hoʻohana ʻia inā ʻaʻole hiki ke hoʻokomo ʻia a hiki ʻole ke tracheotomy.

ʻO nā ʻano paipu i hoʻohana ʻia i ka intubation

Aia nā ʻano like ʻole o nā paipu endotracheal no ka hoʻokomo waha a i ʻole ka ihu; aia nā mea maʻalahi a i ʻole semi-rigid, me kahi ʻano kikoʻī a no laila ʻoi aku ka paʻakikī.

Loaʻa ka hapa nui o nā paipu i kahi palena inflatable e hoʻopaʻa ai i ke ala ea haʻahaʻa, ʻaʻole e ʻae i ka ea e pakele a i ʻole nā ​​mea huna e hoʻomoʻa ʻia.

Intubation: no ke aha i hana ʻia ai i ka wā anesthesia?

Hana ʻia ka intubation e ka mea anesthesiologist i ka wā o ka anesthesia maʻamau, no ka mea - e lawe mai i ka anesthesia - ua hāʻawi ʻia ka mea maʻi i nā lāʻau e kāohi ai i kona hanu: ʻaʻole hiki i ka mea maʻi ke hanu kūʻokoʻa a ʻo ka endotracheal tube, i hoʻopili ʻia i kahi respirator maʻalahi, hiki i ke kumuhana. e hanu pono i ka wā o ka ʻoki.

I nā hana pōkole (a hiki i 15 mau minuke) kākoʻo ʻia ka hanu me ka pale maka, hoʻohana ʻia ka paipu tracheal inā lōʻihi ka hana.

E ʻeha anei au?

Hoʻohana mau ʻia ka intubation ma hope o ka hoʻomoe ʻana o ka mea maʻi, no laila ʻaʻole ʻoe e ʻeha i ka ʻeha.

Ma hope o ke kaʻina hana ʻaʻole ʻoe e hoʻomanaʻo i ke kau ʻana o ka paipu a i ʻole kona wehe ʻana (ʻo ia hoʻi ka extubation) mai ke ala ea i ka wā i pau ai ke kaʻina hana. Hiki ke ʻeha iki ma ka ʻāʻī, a pinepine pinepine, ma hope o ka extubation.

ʻO ka ʻeha ʻāʻī ma hope o ka intubation: he mea maʻamau?

E like me ka mea i ʻōlelo ʻia, ma hope o ke komo ʻana o ka mea maʻi i ka intubation, hiki iā ia ke ʻike i kekahi mau hōʻailona maikaʻi ʻole, e like me:

• eha ka' ā'ī
• manaʻo o ke kino haole i ka puʻu;
• pilikia i ka ale ʻana i nā mea paʻa a me nā wai;
• pilikia i ka wā e kani ai;
• haʻahaʻa.

ʻO kēia mau hōʻailona, ​​ʻoiai he mea hoʻonāukiuki, he pinepine pinepine a ʻaʻole koʻikoʻi, a nalowale koke lākou, maʻamau i loko o ʻelua mau lā.

Inā mau ka ʻeha a ʻaʻole hiki ke hoʻomanawanui, e ʻimi i ka ʻōlelo aʻo mai kāu kauka.

Nā ʻenehana hoʻokomo

Hiki ke hana i ka tracheal intubation me ka hoʻohana ʻana i nā ʻano hana like ʻole.

• ʻO ka ʻenehana kuʻuna: aia kahi laryngoscopy pololei kahi e hoʻohana ʻia ai kahi laryngoscope e nānā i ka glottis ma lalo o ka epiglottis. Hoʻokomo ʻia kahi paipu me ka ʻike pololei. Hana ʻia kēia ʻano hana i nā poʻe maʻi i comatose (ʻike ʻole) a i ʻole ma lalo o ka anesthesia āpau, a i ʻole i ka wā i loaʻa iā lākou ka anesthesia kūloko a i ʻole kikoʻī o nā hale ea o luna (e laʻa me ka hoʻohana ʻana i kahi anesthetic kūloko e like me ka lidocaine).
• ʻO ke kaʻina hana maʻamau i nā poʻe maʻi ma lalo o ka anesthesia. Hana ʻia ia i ka wā e koi ʻia ai ka mālama ʻana i ka ea ma o ka intubation, a ʻoi aku ka nui o ka pilikia o ka inhalation o nā mea huna o ka ʻōpū (aspiration) e aneane hiki ʻole ke alakaʻi i ka pneumonia ab ingestis. No ka RSI, hoʻohana ʻia kahi mea hoʻomaha pōkole e like me etomidate, propofol, thiopentone a i ʻole midazolam, e ukali koke ʻia e kahi lāʻau paralyzing depolarising e like me succinylcholine a i ʻole rocuronium.
• ʻO ke ʻano hana endoscope: ʻo ia ka hoʻohana ʻana i kahi endoscope maʻalahi a like paha (e laʻa me ka hoʻohana ʻana i kahi wikiō-laryngoscope). ʻOi aku ka maikaʻi o kēia ʻenehana i ka wā e manaʻo ʻia ai nā pilikia, no ka mea e hiki ai i ka mea maʻi ke hanu me ka manawa wale nō, no laila e hōʻoiaʻiʻo ai i ka ventila a me ka oxygenation ʻoiai inā he intubation hāʻule.

Loaʻa i ka intubation nā pilikia a me nā pilikia?

Hiki i ka intubation ke hōʻeha i nā niho, ʻoi aku ka nui o nā niho i pohō mua a i ʻole nā ​​pilina anatomical paʻakikī.

Ma waho aʻe o nā hōʻailona hoʻonāukiuki pinepine i ʻike ʻia ma luna, ma nā hihia ʻoi aku ka nui o ka intubation hiki ke hōʻeha nui i nā ʻiʻo e hele ai, a hiki i ka hemorrhaging.

Hiki i ka intubation ke hōʻike i kekahi mau pilikia i manaʻo ʻole ʻia, ʻoi aku ka nui o nā hihia o ka intubation paʻakikī i ʻike ʻole ʻia, he mea kakaikahi akā hiki, kahi o nā hiʻohiʻona anatomical o ka mea maʻi e hoʻonohonoho pono i ka paipu i ke ala ea.

ʻO ka mea pōmaikaʻi, i kēia mau hihia, loaʻa i ke kauka nā mea hana e kōkua iā ia e kaupalena i nā pilikia i ka mea maʻi e like me ka hiki, e like me ka videolaryngoscopes a me nā fiberscopes, e hana ana i nā pilikia intubation i ʻike ʻole ʻia.

ʻOi aku ka schematically, nā pilikia mua a me ka hope e like me kēia:

Nā pilikia mua

• ʻeha niho
• ʻeha ʻāʻī;
• kahe koko;
• ka edema o nā hale glottic;
• pneumomediastinum;
• haʻahaʻa;
• pilikia phonatory;
• ka puka ʻana o ka tracheal;
• ka hopu ʻana i ka maʻi cardiovascular mai ka hoʻoulu ʻana i ka vagal.

Nā pilikia lohi

• ʻeha ʻūhā
• chordal decubitus;
• nā hale decubitus buccal, pharynx, hypopharynx;
• pulumonia;
• sinusitis.

E heluhelu pū nō hoʻi:

ʻO ka Emergency Live Aʻoi aʻe ... Ola: Hoʻoiho i ka polokalamu manuahi hou o kāu nūpepa no IOS a me Android

UK / Keʻena ʻEpekema, Pediatric Intubation: ʻO ke kaʻina hana me kahi keiki i ke kūlana koʻikoʻi

Hoʻopau Endotracheal i nā maʻi Pediatric: Pūnaewele No nā Alanui Supraglottic

ʻO ka hemahema o nā sedatives e hoʻonui i ka maʻi ahulau ma Brazil: Lapaʻau nā lāʻau lapaʻau no ka mālama ʻana i nā mea maʻi me Covid-19.

ʻO ka Sedation a me ka analgesia: nā lāʻau lapaʻau e hoʻomaʻamaʻa i ka intubation

Anxiolytics a me nā mea hoʻomaha: kuleana, hana a me ka hoʻokele me ka intubation a me ka hoʻokele mīkini.

ʻO New England Journal of Medicine: Nā Intubations kūleʻa me ke kiʻekiʻe-kahe nasal Therapy i nā keiki hānau hou

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