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首页> 外文期刊>The Internet Journal of Academic Physician Assistants >Airway Management: The Basics Of Endotracheal Intubation
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Airway Management: The Basics Of Endotracheal Intubation

机译：气道管理：气管插管的基础知识

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Airway management (AM) can be life-saving in certain emergency situations. Physician assistants may encounter patients requiring AM in virtually any clinical setting. Endotracheal intubation (EI) is indicated in several clinical situations including respiratory failure, cardiorespiratory arrest, upper airway obstruction, in patients at risk for aspiration, and for certain elective procedures. It is mandatory that a clinician responsible for airway management be familiar with airway anatomy and how it pertains to intubation. Ideally, prior to attempting EI, all necessary equipment, medications, emergency supplies, and support staff should be in place. Patients should be monitored before, during and after intubation. Proper technique of EI is reviewed, as well as assessment of proper endotracheal tube placement. INTRODUCTION Physician assistants (PAs) can encounter patients that require airway management (AM) in virtually any clinical setting. All PAs should therefore be familiar with the basics of these potentially life-saving procedures. This article is meant to serve as a general introduction to one of the techniques of AM, endotracheal intubation (EI) of the adult patient.PAs who work in environments where patients are likely to need AM should obtain training and experience in the proper technique of EI, medications used for the procedure, as well as alternative methods of AM when EI is unsuccessful (see Table 1). A subsequent article in this series will review alternative techniques in AM, including those useful for the less experienced clinician in emergency situations.TABLE 1: Alternative techniques to establish an airway Oral Airway Nasal Airway Mask Ventilation Transtracheal Jet Ventilation Retrograde Intubation Laryngeal Mask Airway Light Wand Blind Nasal Intubation Combitube Emergency Cricothyrotomy Devices INDICATIONS for ENDOTRACHEAL INTUBATIONEndotracheal intubation is indicated in several clinical situations including acute hypoxemic or hypercapnic respiratory failure, or impending respiratory failure.1 2 3 4 This procedure is also used to protect the airway in conditions of upper airway obstruction, either mechanical or from airway pathology.1-4 Patients at risk for aspiration, most commonly from central nervous system derangements may benefit from elective intubation.2-5In addition, elective EI is performed for many operative procedures; at times to facilitate certain diagnostic procedures (ex. computed tomographic scan); and to aid in respiratory hygiene.1-4 Another potential indication for EI includes the need to hyperventilate by mechanical ventilation, attempting to reduce intracranial pressure in patients with acute intracranial hypertension.6 AIRWAY ANATOMYEndotracheal intubation can be performed either orally or nasally, although oral intubation is the more commonly used technique.5The nasopharynx and oropharynx lead to the laryngopharynx (hypopharynx). At the base of the tongue, the epiglottis separates the larynx from the laryngopharynx. The epiglottis serves as a protective mechanism for preventing aspiration by covering the opening of the larynx (i.e. the glottis) during swallowing.The larynx, composed of cartilages, connecting ligaments and muscles, establishes the boundary of the upper and lower airway. The glottis divides the larynx into a superior compartment (from the laryngeal outlet to the vocal cords) and an inferior compartment (from the vocal cords to the lower border of the cricoid cartilage), which leads to the trachea. In the adult, the airway is narrowest at the vocal cords and in small children at the cricoid cartilage ring.The trachea begins at the level of the cricoid cartilage and extends to the carina. The carina (at the level of the angle of Louis, about T5)7is the point of airway bifurcation, leading to the left and right main stem bronchi. The right main stem bronchus is less angulated from the trachea than is the left main stem bronchus (25 versus 45 degrees)7and therefore is mo
机译：在某些紧急情况下，气道管理（AM）可以挽救生命。几乎在任何临床情况下，医师助理都可能会遇到需要AM的患者。气管插管（EI）在几种临床情况下适用，包括呼吸衰竭，心肺骤停，上呼吸道阻塞，有抽吸危险的患者以及某些选择性手术。负责气道管理的临床医生必须熟悉气道解剖结构及其与插管的关系。理想情况下，在尝试进行EI之前，应准备好所有必要的设备，药物，应急物资和支持人员。插管前，插管中和插管后应监测患者。 EI的正确技术进行了回顾，并评估了气管插管的正确位置。简介医师助理（PA）几乎可以在任何临床环境中遇到需要气道管理（AM）的患者。因此，所有PA都应熟悉这些可能挽救生命的程序的基础知识。本文旨在对成年患者AM的一种技术进行总体介绍，即气管插管（EI）。在可能需要AM的患者环境中工作的PA应当接受适当的技术培训和经验EI，该过程中使用的药物以及EI不成功时的AM替代方法（请参见表1）。本系列的后续文章将回顾AM中的替代技术，包括那些对紧急情况下经验不足的临床医生有用的技术。表1：建立气道的替代技术口腔气道鼻气道面罩通气经气管喷射通气逆行插管喉罩气道灯棒盲鼻插管Combitube紧急开颅手术设备气管插管的适应症在几种临床情况下，包括急性低氧血症或高碳酸血症性呼吸衰竭或即将发生的呼吸衰竭，都需要进行气管插管。12 3 4此方法还用于在上呼吸道阻塞的情况下保护气道1-4机械性或气道病理。1-4可能有误吸危险的患者，最常见的是中枢神经系统紊乱，可能会从选择性插管中受益。2-5此外，对于许多手术方法，都进行了选择性EI。有时会促进某些诊断程序（例如计算机断层扫描）; 1-4 EI的另一个潜在适应症包括需要通过机械通气进行过度换气，以试图降低急性颅内高压患者的颅内压。6气道解剖法尽管经口也可以经口或经鼻气管插管气管插管是更常用的技术。5鼻咽和口咽导致喉咽（下咽）。会厌在舌根处将喉与喉咽分开。会厌通过吞咽时覆盖喉部（即声门）的开口来作为防止误吸的保护机制。喉部由软骨，连接韧带和肌肉组成，确定了上呼吸道和下呼吸道的边界。声门将喉分为上腔室（从喉部出口到声带）和下腔室（从声带到环状软骨的下边界），通向气管。在成年人中，气道在声带最窄，在小孩中在环形软骨环处最狭窄。气管始于环形软骨的水平并延伸至隆突。隆鼻（在路易斯角的水平，大约T5处）7是气道分叉点，通向左右主干支气管。右主干支气管与气管的角度比左主干支气管的角度小（25度与45度）7，因此

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