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- Oxygenation = Preoxygenation + Apneic preoxygenation
- PPAP : Position, Preoxygenation, Apneic preoxygenation, Intubation Plan
- PPAP : Position, Preoxygenation, Apneic preoxygenation, Intubation Plan
- Preoxygenation : 通氣最重要, Goal : SpO2 100% 3 mins
Position : Head up 30 degrees
- 能自呼的用 NRM 30-60L/min (Flush rate)
15 L/min 無法達到 FiO2 100% (esp in dyspnea patient)
- Preoxygenation 唯二選擇 : NRM flush rate or passive BVM
解決 Shunt 要靠 PEEP : BVM + PEEP valve 15cm H2O or VAPOX
- 再怎麼 Preoxygenation 都 SpO2 88 % : 還是要 Preoxygenation ! 能撐更久 !
Position : Head up 30 degrees
- 能自呼的用 NRM 30-60L/min (Flush rate)
15 L/min 無法達到 FiO2 100% (esp in dyspnea patient)
- Preoxygenation 唯二選擇 : NRM flush rate or passive BVM
解決 Shunt 要靠 PEEP : BVM + PEEP valve 15cm H2O or VAPOX
- 再怎麼 Preoxygenation 都 SpO2 88 % : 還是要 Preoxygenation ! 能撐更久 !
- BVM 擠快一點沒差別
- 還是要給 Sedation, Preoxygenation 後 RSI, 打完 RSI 馬上就該插管
- Apneic preoxygenation : 15L N/C
- Straight to the cuff better than arcuate (curved) shape
- External Laryngeal Manipulation (ELM) : bimanual laryngoscopy
This is NOT BURP or cricoid pressure.
- Head Elevated Laryngoscopy Positioning (HELP)
- 還是要給 Sedation, Preoxygenation 後 RSI, 打完 RSI 馬上就該插管
- Apneic preoxygenation : 15L N/C
- Straight to the cuff better than arcuate (curved) shape
- External Laryngeal Manipulation (ELM) : bimanual laryngoscopy
This is NOT BURP or cricoid pressure.
- Head Elevated Laryngoscopy Positioning (HELP)
- Difficult airway can still RSI ? Yes !
如果用了能幫助通氣插管而且有 back up plan 該用不用最後還是會走到氣切
- 氣切不是永遠都是 Rescue plan 請 Double play 同時準備 ! 一試不行就切 !
- Laryngeal hand shake 鎖喉手定位
- 氣切總是血肉模糊, 善用手指觸覺定位
https://www.emnote.org/emnotes/airway-management-in-obese-patients
https://www.aclsmedicaltraining.com/blog/how-to-master-tracheal-intubation/?fbclid=IwAR003qQW81CHyVbiockFjGAkffYy6aX1L0V2Lc4svn7slztLQRurhWw1gMI
https://www.aclsmedicaltraining.com/blog/how-to-master-tracheal-intubation/?fbclid=IwAR003qQW81CHyVbiockFjGAkffYy6aX1L0V2Lc4svn7slztLQRurhWw1gMI
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