TAILIEUCHUNG - AIRWAY MANAGEMENT IN EMERGENCIES - PART 3

Âm thanh: Một số điều kiện liên kết với âm thanh đường hô hấp bất thường trên và dưới có thể gây ra khó khăn với BMV. Một lịch sử của chứng ngáy đã được tương quan với với các bệnh nhân béo phì, điều này có thể được kết hợp với mô dự phòng hầu họng. | OXYGEN DELIVERY DEVICES AND BAG-MASK VENTILATION 49 .Sounds A number of conditions associated with abnormal upper and lower airway sounds may cause difficulty with BMV. A history of snoring has been correlated with As with the obese patient this may be associated with redundant oropharyngeal tissues. Early placement of an OPA and maintaining a head-extended position will help. Stridor is almost always a sign of pathologic airway obstruction and should be considered an ominous sign. Any patient presenting with inspiratory or expiratory stridor should be considered as potentially very difficult or impossible to bag-mask ventilate. The patient with stiff poorly compliant lungs often associated with wheezing or rales will present increased resistance to bag-mask ventilation and requires higher than normal insufflation pressure. The presence of two or more of the factors presented above significantly increases the potential for The true incidence of DMV in the emergency department ED is not clear but is likely greater than that seen with the elective surgical population. In the operating room DMV has been reported to occur in up to 5-8 of elective surgical 21 Interestingly the DMV rate is twice as high in patients who were also described as difficult Prediction of difficulty with BMV is an important component of the airway assessment as BMV remains the go to method of gas exchange both before and between intubation attempts. It also represents a vital decision node in airway management in two ways A. Decision making Anticipated difficulty with BMV may point to the need for an awake technique for intubation especially if difficulty with laryngoscopy is also predicted see Chap. 11 . B. Defining the failed airway In the setting of failed intubation the inability to maintain the SaO2 90 with BMV defines failed oxygenation mandating proceeding with rescue oxygenation via an extraglottic device or cricothyrotomy see Chap. 12 . One

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