气道的评估和管理Airway-Evaluation-and-Management.ppt

Airway Evaluation and Management II. EVALUATION 5. Trauma may be associated with airway injuries, cervical spine injury, basilar skull fracture, or intracranial injury. 6. Previous surgery, radiation, or burns may produce scarring, contractures, and limited tissue mobility. 7. Acromegaly may cause mandibular hypertrophy and overgrowth and enlargement of the tongue and epiglottis. 8. Scleroderma may produce skin tightness and decrease mandibular motion and narrow the oral aperture. II. EVALUATION 9. Trisomy 21 patients may have atlantoaxial instability and macroglossia. 10. Dwarfism. 11. Other congenital anomalies may complicate airway management. B. Physical Examination 1. Specific findings that may indicate a difficult airway include the following: a. Inability to open the mouth. b. Poor cervical spine mobility. c. Receding chin (micrognathia). II. EVALUATION d. Large tongue (macroglossia). e. Prominent incisors. f. Short muscular neck. 2. Injuries to the face, neck, or chest must be evaluat-ed to assess their contribution to airway compromise. 3. Head and neck examination. There is no single best predictor of difficult airway management on the physical exam, so a detailed exam is in order. 4. The Mallampati classification III. MASK AIRWAY A. Indications 1. To preoxygenate (denitrogenate) a patient before endotracheal intubation. 2. To assist or control ventilation as part of initial resuscitation before an ETT is placed. 3. To provide inhalation anesthesia in patients not at risk for regurgitation of gastric contents. 2 .Mask placement. with one hand with two hands III. MASK AIRWAY D. Complications. The mask may cause pressure injuries to soft tissues around the mouth, mandible, eyes,or nose. Loss of the airway may result from laryngospasm or vomiting. Mask ventilation does not protect the airway from aspiration of gastric contents. Laryngospasm, a tonic contra