Emergency Live | Airway Management Guidelines could change quickly — Kuwongolera kwa airway kuli pafupi kwambiri ndi gawo lina mtsogolo

Ubwino ndi Zowopsa za Prehospital Drug Assisted Airway Management (DAAM)

By Cristiano Antonino On Dis 28, 2022

Zokhudza DAAM: Kuwongolera ndege ndi njira yofunikira pazochitika zambiri zadzidzidzi - kuchokera panjira yapaulendo mpaka kulephera kupuma komanso kumangidwa kwa mtima.

Komabe, malingana ndi momwe matenda a wodwalayo alili ovuta, komanso kuwonongeka kwa njira zothandizira, kuyendetsa ndege nthawi zambiri kumayambitsa zotsatira zoipa kwa odwala m'maganizo ndi m'thupi.

Muzochitika zina za prehospital, odwala nthawi zina amapindula ndi Drug Assisted Airway Management (DAAM), yomwe imatha kupititsa patsogolo laryngoscopy kwa opereka chithandizo ndikuyika mosavuta ma endotracheal chubu ndi ma supraglottic airways panthawi yolowera.

Kuti apereke chithandizo chamankhwala chothandiza komanso chotetezeka kwa odwala, opereka EMS ayenera kudziwa za mapindu a DAAM ndi momwe angachitire bwino, komanso kuopsa kwake komwe kumakhudzana ndi izi.

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DAAM ndi chiyani?

Malinga ndi chikalata chochokera ku National Association of EMS Physicians (USA), Drug Assisted Airway Management (DAAM) imatanthawuza kasamalidwe ka mankhwala osokoneza bongo okha, kapena ophatikizana ndi neuromuscular blockers, kuyambitsa kuyika kwapanjira kwa odwala omwe ali ndi vuto loyendetsa ndege kapena lomwe likubwera. kulephera kupuma, omwe amathanso kuvutika ndi kusintha kwamaganizidwe, kukwiya kapena kukhazikika kwachitetezo cha airway reflex.

Kusiyanasiyana kwamakono kwa DAAM komwe kumagwiritsidwa ntchito kawirikawiri pachipatala cha prehospital kumaphatikizapo sedation-assisted intubation (SAI), kuchedwa kwa sequence intubation (DSI) ndi mofulumira sequence intubation (RSI).

RSI, yodziwika kwambiri mwa atatuwa, imaphatikizapo kuwongolera kwa sedative ndi opuwala kwa endotracheal intubation odwala.

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Zochitika zomwe DAAM ingavomerezedwe

Zina zadzidzidzi zomwe zingafunike DAAM zikuphatikizapo sitiroko, kuvulala kwa ubongo (TBI) ndi kulephera kupuma kuchokera ku matenda a pulmonary kapena mtima.

DAAM iyenera kuchitidwa kokha pamikhalidwe yokwanira yomwe zipangizo zoyenera ndi malangizo ali nazo, ndipo maphunziro okwanira ndi kuyang'anira madokotala a EMS kulipo.

Othandizira ayenera kuyeza mozama zomwe zingapindule zachipatala motsutsana ndi zoopsa za DAAM

Ngakhale kuti wodwala ali ndi vuto, asanachite DAAM, mabungwe a EMS ayenera kuonetsetsa kuti opereka chithandizo aphunzitsidwa bwino kuti athe kusamalira odwala omwe ali ndi vuto, kuphatikizapo panthawi ndi pambuyo pa kulephera kwa DAAM, komanso kuti ali ndi zofunikira. zida pamanja kuti mupereke mankhwala ndi intubate motetezeka komanso bwino momwe mungathere.

Zina mwa zida ndi njira zofunika pochitira DAAM ndi monga mpweya wa chigoba cha thumba, zida zapanjira ya supraglottic komanso njira zopangira opaleshoni.

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Kudziwa kuopsa kwake

Mlingo wa chiwopsezo chokhudzana ndi kuchita DAAM umadalira zinthu zingapo zokhudzana ndi mbiri ya wodwalayo, mkhalidwe wake ndi zosowa zake, komanso kuchuluka kwa chidziwitso ndi kukonzekera kwa opereka chithandizo.

Asanalowetsedwe, ndikofunikira kuti opereka chithandizo amuyeze wodwalayo kuti amvetsetse bwino chiwopsezo / phindu lakuchita DAAM, mosiyana ndi njira zotsatizana mwachangu kapena njira zina zopumira.

Pakuwunika, opereka chithandizo ayenera kuyang'ana zizindikiro zilizonse zomwe zikuwonetsa kuthekera kovutirapo, monga kukhalapo kwa mano akutsogolo, mbiri ya intubation yovuta, mphambu iliyonse ya Mallampati yosiyana ndi imodzi kapena yofanana ndi inayi, ndi kutsegula pakamwa zosakwana 4. centimita.

Zowopsa zazikulu zimalumikizidwanso ndi zovuta zapamsewu wodwala, monga kukula kwanjira yapaulendo, khosi kusayenda, kutsegula pakamwa, kusayenda bwino komanso kutuluka magazi.

Kuonjezera apo, ngati yachitidwa molakwika, DAAM ikhoza kuyambitsa zovuta zowonjezera kuyika kwa ndege chifukwa cha kutayika kwachangu ndi kotheratu kwa chitetezo cha mpweya ndi kupuma, komanso kuthekera kwa mankhwala kuonjezera zovuta za thupi la odwala.

Kupanga chisankho mwanzeru

Ngakhale pali zochitika zosiyanasiyana za chisamaliro cha prehospital zomwe zingafunike kugwiritsa ntchito DAAM, monga momwe odwala akukumana ndi vuto lamisala kapena akuvutika ndi zovuta zachipatala zomwe zingayambitse kupuma, DAAM imakhalanso ndi chiopsezo chachikulu kwa odwala.

Ndikofunikira kuti opereka chithandizo cha EMS adziwe zoopsazi komanso momwe zimasiyanirana ndi odwala, komanso kuti ali ndi maphunziro oyenera komanso zothandizira kuchepetsa zoopsa momwe angathere pochiza odwala.