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Challenges facing the anesthesiologist in the emergency department

机译：急诊科麻醉师面临的挑战

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摘要

This review focuses on developments in airway management and concious sedation/analgesic techniques employed by anesthesiologists in the emergency department.Emergency medicine physicians routinely employ airway devices and techniques that were previously reserved for anesthesiologists. An understanding of the uses and limitations of these devices are essential for successful outcomes. Anesthesiologists responding to the emergency department may be faced with soiled or traumatized airways. The use of newer devices in cervical trauma and the difficult airway is reviewed. Consious sedation in the emergency department is also reviewed. There are no published recommendations demonstrating the advantage of specific agents for sedation in the emergency department. A wide variety of medications and techniques are currently being employed. Studies indicate that the incidence of adverse effects from these agents range from less than 1% to almost 30%. Various organizations have published guidelines detailing the appropriate protocols and equipment that must be present in the emergency department to monitor patients undergoing conscious sedation. These recommendations have not been universally implemented, and several recent studies suggest that a substantial number of emergency departments may have major deficiencies.The consultant anesthesiologist responding to a critical airway may face a variety of challenges, including traumatized or soiled airways, patients with cervical spine fractures, and patients who have undergone sedation techniques that may have progressed to deep and general anesthesia. Anesthesiologists may also face the challenge of responding to these emergent situations without all the equipment or adequately trained support staff necessary to handle those emergencies safely.
机译：这篇综述的重点是急诊科麻醉师使用的气道管理和镇静/镇痛技术的发展。急诊医学医师通常采用以前为麻醉师保留的气道设备和技术。了解这些设备的用途和局限性对于取得成功的结果至关重要。响应急诊科的麻醉师可能会遇到呼吸道被污染或受到创伤的情况。审查了在宫颈外伤和气道困难中使用新设备的情况。还对急诊科中的镇静镇静进行了审查。没有公开的建议证明在急诊室使用特定药物镇静的优势。当前正在使用各种各样的药物和技术。研究表明，这些药物产生不良反应的发生率从不到1％到几乎30％。各种组织已经发布了指南，其中详细介绍了急诊部门中必须存在的适当协议和设备，以监视进行清醒镇静的患者。这些建议尚未得到普遍实施，最近的一些研究表明大量急诊科可能存在重大缺陷。应对严重气道进行咨询的麻醉师可能会面临各种挑战，包括气道受创或脏污，颈椎病患者骨折，以及接受过镇静技术的患者，这些患者可能已经进行了深度麻醉和全身麻醉。在没有安全处理这些紧急情况所需的所有设备或训练有素的支持人员的情况下，麻醉师也可能面临应对这些紧急情况的挑战。

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