国际创伤生命支持ITLS-03-气道处理Chapter4_Airway_SC.ppt

* * NOTE: This lecture is designed to convey key points of Airway Management. Adjuncts will be taught in Skill Stations—do not duplicate teaching material. No task is more important than that of airway control. Maintaining an open airway and adequate ventilation in a trauma patient can be a challenge. Frequently are in need of immediate help. Airway control in trauma patient is rooted in several fundamental truths: Air should go in and out, oxygen is good, and blue is bad. Everything else follows from these. * IMAGE: Cutaway view of a normal, healthy human subject with nasal passages, sinuses, trachea, and lungs with bronchial tubes branching in a sectioned view of right lung and an inset showing alveolar sacs. Review basic anatomy and physiology. Airway begins at tip of nose and lips and ends atalveolocapillary membrane, through which gas exchange takes place between air sacs of lung (thealveoli) and lungs capillary network. Airway consists of chambers and pipes, which conduct air with its 21 percent oxygen content to alveoli and carry away wastecarbon dioxidethat diffuses from blood into alveoli. * Nasopharynx Nasal cavity and oropharynx are lined with moist mucous membranes that are delicate and highly vascular. Nasal cavity divided by very vascular midline septum. Turbinates can get in way when inserting tubes. Nasal adjuncts should go straight back, not up. Decrease incidence of trauma through liberal lubrication of tubes and avoiding unnecessary poking about. Oropharynx Possible obstructions in this include teeth and tongue. Muscles of jaw (including tongue muscle) attached to hyoid bone. Epiglottis (and other airway structures) attached to hyoid bone. Therefore, lifting jaw opens airway by lifting tongue and epiglottis. Hypopharynx Epiglottis is one of main anatomic landmarks. Epiglottis is floppy piece of cartilage covered by mucosa. Tongue can produce some airway obstruction, but epiglottis can produce complete airway obstruction in supine unconscious