UK / Igumbi likaxakeka, intubation yabantwana: inkqubo kunye nomntwana okwimeko embi
Intubation kwisebe elingxamisekileyo labantwana zizinto ezoyikisayo. Kubantwana abagula kakhulu abafuna intubation, ayifane yenziwe ngaphandle kweyunithi yokhathalelo olunzima
Ngokudityaniswa kweenkonzo kwindawo enye kukho ancitshisiweyo amathuba okuba ezi zakhono zenziwe. Abo basebenza kwii-DGH banokuba namathuba ambalwa okuziqhelanisa ezi zakhono - kwaye xa besenza oko kunokuba kwimeko engxamisekileyo.
Oku kunokuncediswa ngentsebenziswano namaqela onyango lwabantwana anokuthi anike iingcebiso ezikude kwabo bakwindawo engeyoyamaziko emfundo ephakamileyo de kufike iqela lokubuyisela. Nangona kunjalo, ulawulo lulonke lusenokubakho kwiqela lendawo.
Inqaku lakutshanje nguKanaris et al. ijolise ekunikeni iingcebiso malunga nendlela yokubonelela nge-intubation ekhuselekileyo, ekhawulezayo eyimpumelelo kunye neminye imigibe eqhelekileyo kunye nendlela yokuyoyisa (eyenze isiseko sesi sithuba).
Intubation yabantwana kwigumbi likaxakeka: The 3Ps- Planning | Ukulungiselela | Inkqubo
Kubalulekile ukuba isicwangciso esifanelekileyo senzeke nakwimeko yongxamiseko. Izinto ezininzi kufuneka zenzeke ngokukhawuleza.
Isinyathelo sokuqala kufuneka sigxininise kuqeqesho kunye nokulinganisa ezi nkqubo - ngokufanelekileyo kuyo nayiphi na indawo ekhankanywe ngasentla.
Malunga ne-intubation yabantwana kwigumbi likaxakeka: vuselela ngaphambi kokuba ungene
Ukufakela umntwana ogula kakhulu yinkqubo enobungozi. Ukungeniswa kunethuba lokwenyani lokubangela ukubanjwa kwentliziyo kwi-induction.
Oku kunokwenzeka ngakumbi ukuba umntwana akazange avuselelwe ngokufanelekileyo.
Ukulawulwa kwamanzi (10mls / kg aliquots - ukuya kwi-40-60mls / kg) kubantwana abane-hypotensive kunye ne-tachycardic, okanye igazi kubantwana abaye balahlekelwa yigazi kubalulekile.
Ngokwesikhokelo esitsha sebhunga le-resus elinganayo i-isotonic crystalloids, umzekelo, iPlasmalyte, ngoku lukhetho lokuqala.
Inkxaso ye-inotropic ye-peripheral nayo ingafuneka kunye ne-adrenaline / noradrenaline.
Kumntwana owothukileyo ukufumana ufikelelo lwe-IV kunokuba nzima - ukufikelela kwe-IO kunokuba yindlela ekhawulezayo, elula nesebenzayo.
Oku kunokubonwa 'njengofikelelo oluphakathi' lwethutyana olunokuba luncedo ngakumbi kwi-ED resus.
Ukubekwa komgca ophakathi kule meko kunokuthatha ixesha kwaye kunokuphazamisa iqela kwezinye izenzo eziphambili.
IMPILO YABANTWANA: FUNDA OKUNGAKUMBI NGOKWENZEKA NGOKUVAKASHA KWI-STAND KWIMiboniso ENGXAMISEKILEYO
Masithethe Amachiza...
Njengezinto ezininzi kunyango lwabantwana, akukho chiza 'ligqibeleleyo' okanye indibaniselwano yamachiza e-anesthesia kwimeko kaxakeka.
Inhlanganisela ekhuthazwayo kwaye ixhomekeke kumaqela okunyamekela okubalulekileyo yiKetamine (1-2mg / kg) (+/- Fentanyl 1.5 microgram / kg) kunye neRocuronium (1mg / kg).
Ii-anesthetists ezinokuthi ziqhelene nabantu abadala zingasetyenziselwa ukusebenzisa amachiza afana nepropofol okanye i-thiopentone.
Ezi zombini zineziphumo ezibalulekileyo ze-vasodilatory kwaye ngokwenene kufuneka zigcinelwe kuphela abantwana NGAPHANDLE naziphi na iimpawu ZOKUTSHATHEKA.
Oogxa abadala banokuba sekhaya ngakumbi ngokusebenzisa i-suxamethonium kune-rocuronium.
I-Suxamethonium isebenza ngokukhawuleza inikezela ukukhubazeka kwimizuzwana engama-30-60.
Isebenza ngokukhawuleza kodwa ayihlali ixesha elide (2-6mins), inokubangela ukuba i-bradycardia kunye nokukhululwa kwe-potassium.
I-Rocuronium, xa isetyenziswe kwi-dose efanelekileyo, inokuba nesiqalo esifana neso (imizuzwana ye-40-60) ngaphandle kwemiphumo engafunekiyo.
I-Rocuronium inokuguqulwa kwakhona xa ifunwa nge-sugammadex ukuba iyimfuneko.
Indawo, indawo, indawo
Ukuhamba ukusuka kwi-ED ukuya kwiithiyetha ukuququzelela intubation kunokuba yinto enzima.
Oku kungakhethwa ngenxa yokuqhelana nayo izixhobo kunye nesithuba seqela le-intubating, indawo enokubakho ngakumbi, kunye nokukwazi ukusebenzisa iigesi ze-anesthetic kwimeko yobunzima bomoya.
Ezinye izixhobo umz. i-laryngoscope yevidiyo inokufumaneka lula kwi-CCU/Iithiyetha.
Nangona kunjalo, kuhlala kukho umngcipheko wokuwohloka okunokwenzeka kuhambo olusuka kwi-resus ukuya kwenye indawo.
Ukuba ubambekile kwilifti kunye nomntwana ongazinzanga ngokugxekayo, ayisosikhundla esinqwenelekayo ukuba ube kuso.
Ukuba, njengeqela, isigqibo senziwe sokudlulisela isigulana, ukucwangciswa ngenyameko malunga nokuba ngubani kunye nento onokuyidinga ngokumalunga nabasebenzi kunye nezixhobo kubalulekile.
Ukuqinisekisa ukubeka iliso: i-pulse oximetry, i-ECG, ukuhamba ngebhayisikile i-NIBP kwaye ngokuqinisekileyo ngokomgaqo omtsha webhunga le-resus capnography ekhoyo phambi kokuhamba ibalulekile.
Umsebenzi ohluphekayo ugxeka izixhobo zakhe… Kodwa kufuneka uqinisekise ukuba unazo ezifanelekileyo.
Kwimeko engxamisekileyo yexesha elingxamisekileyo, kunye neqela elisanda kuhlanganiswa, ukuba nezixhobo ezifanelekileyo kubalulekile.
Uluhlu lokuhlola intubation luvumela abantu ukuba baqokelele izixhobo ezifanelekileyo ngaphandle kokuba umntu kufuneka athathe oku njengomthwalo wokuqonda.
Mininzi imizekelo yoluhlu lokukhangela izixhobo ze-intubation. Jonga kwiimbekiselo zeminye imizekelo.
Ukongeza ekubeni noluhlu lokukhangela intubation, luluvo oluhle ukuba noluhlu lokukhangela olusebenza njengohlobo lwephepha lokungena/lokuphuma le-WHO elinokubandakanya izixhobo ezifunekayo.
Zeziphi isayizi iicuffs?
Iityhubhu ezifakwe kwi-cuffed ngumgangatho wegolide kubantwana abagula kakhulu>3kg.
Intubation yabantwana kwigumbi elingxamisekileyo: I-oxygenation, i-oxygenation kunye ne-oxygenation engaphezulu
Xa kuziwa ekufakeni i-oxygen isigulane ngaphambi okanye phakathi kwemizamo ye-intubation, i-standard bag-valve-mask okanye i-anesthetic circuit ingasetyenziswa.
Into ekufuneka iqwalaselwe inokuthi ibeke umntwana kwi-high flow humidified oxygen (100%) nge-HFNC ukuphucula i-oxygenation ngaphambi naphakathi kwemizamo.
Ukuba oku kuthatha ixesha elide kakhulu okanye izixhobo zempumlo zichaphazela itywina lemaski yobuso, ungayenzi.
Injongo yeyokuba yimizuzu emi-3 ye-pre-oxygenation phambi kokuba kufakwe i-intubation - kubantwana abancinci/abagulayo ithuba lokuphuma kwe-apnoeic desaturation liphezulu njengoko bendanda kwi-cliff ebalulekileyo ye-oxygen-hemoglobin dissociation curve.
Kubalulekile ukuba ne-NGT enokunqweneleka rhoqo kubalulekile ukunciphisa isisu esigcweleyo (nokuba sisiqulatho sesisu okanye umoya) kwaye uthintele ukuqhekeka kwe-diaphragm, kunye nokunciphisa umngcipheko wokulangazelela.
Ngalo lonke ixesha khumbula eyona njongo iphambili - ukuhambisa i-oxygen kwisigulane. Thatha inyathelo emva, ukuba kuyimfuneko ukuba uzikhumbuze wena kunye neqela lenjongo yokugqibela.
Uyakwazi ukufaka i-oxygen ngeendlela ezilula kwaye ngaloo ndlela unqande iinzame ezininzi zokungena.
'Ubuchule beVortex' bunokuba luncedo njengoncedo olubonakalayo ukukhumbuza iqela ukuba lithathe inyathelo lokubuya umva.
Unako ukugcina i-airway kunye ne-adjuncts kunye ne-bagging isigulane inokwenziwa de kufike uncedo olungakumbi.
Ukusebenzisana kwenza iphupha lisebenze
Ukuba neqela eligrunjwe kakuhle nelinezakhono liphupha. Enyanisweni, siyazi ukuba oku akusoloko kunjalo.
Iintshayelelo ezimfutshane ezinengcaciso yeendima kunye nesicwangciso sokwenza esifutshane (kubandakanya isicwangciso B, C kunye no-D) ukuba izinto azihambi kanye njengoko bekucwangcisiwe ziluncedo.
Yenza kucace ukuba ngubani okhokelayo kwaye udlulisele ubunkokeli ngokufutshane ngexesha le-intubation ngokwayo ukuba kuyimfuneko.
Yabela ilungu leqela ukuba ligcine iliso kwiwotshi ngexesha lokungena.
Oku kunokuthintela i-intubator ekubeni 'igxininise kakhulu kumsebenzi'.
Kwakhona 'i-oxygenation', hayi 'intubation' yeyona njongo iphambili apha.
Njengayo nayiphi na inkqubo esemngciphekweni omkhulu, ukulinganisa kubalulekile, kudityaniswa nenkcazo emva kokuba isiganeko ngokwaso senzeke ukuze kubonwe ukuba zeziphi iibhithi ezisebenze kakuhle kwaye ngawaphi amanqaku okufunda anokwenziwa.
Funda kwakhona:
I-Endotracheal Intubation kwizigulana zabantwana: Izixhobo zeSupraglottic Airways
imvelaphi:
Iimbekiselo ezikhethiweyo
Ezinye izixhobo zokuHlola ze-Intubation zasimahla zimi ngolu hlobo lulandelayo. Enkosi kuluntu lweDFTB ngokusayina kolu luhlu luluncedo:
https://kids.bwc.nhs.uk/wp-content/uploads/2021/02/Pre-Intubation-Checklist-V25Final.pdf
Izixhobo zokuvuselela abantwana | Ukhathalelo loNgxamiseko lwaBantwana eQueensland (health.qld.gov.au)
Isicwangciso soMoya kunye neKit yokuLahla – KI Doc (kidocs.org)
UAnandi Singh, uJilly Boden kunye noVicki Currie. 2021 Resuscitation Council UK Guidance: Yintoni entsha kwizigulo zabantwana?, Ungalibali iBubbles, 2021. Ifumaneka apha: https://doi.org/10.31440/DFTB.33450
Indlela yeVortex: http://vortexapproach.org/downloads– Luninzi lweenkcukacha eziluncedo ngokwenene/ ushicilelo olunokusetyenziswa kwitroli yeresus!