急診醫師專訪系列之二(下集)
急診醫師專訪系列之二(上集)
Reuben Strayer: Leisurely Laryngoscopy (SMACC DUB)
Position
head at head of bed, or beyond (occiput off)
ear to sternal notch
head of bed up
Levitan RM, Mechem CC, Ochroch EA, Shofer FS, Hollander JE. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med. 2003;41(3):322-30.
look into the mouth; not get into the mouth
Start laryngoscopy early (but with deliberated slowness)
Incremental Goal Directed Tracheal exposure (IGDT)
lead with suction
soft palate → uvula → posterior wall → epiglottis → interarytenoid notch
ELM (external laryngeal manipulation)
Eschmann Introducer (Gum Elastic Bougie)
Assistant
拉嘴角
Jaw Thrust Maneuver
Corda, David M., Kevin T. Riutort, Alex J. Leone, Mueez K. Qureshi, Michael G. Heckman, and Sorin J. Brull. "Effect of Jaw Thrust and Cricoid Pressure Maneuvers on Glottic Visualization during GlideScope Videolaryngoscopy." Journal of Anesthesia J Anesth 26.3 (2012): 362-68.
3 Finger Tracheal Palpation
Gamble, Jonathan J. "Three-Finger Tracheal Palpation to Guide Endotracheal Tube Depth in Children." Pediatric Anesthesia Paediatr Anaesth 24.12 (2014): 1312-313.
Scott Weingart: Post-Intubation Sedation (SMACC DUB)
止痛先於鎮靜
1mg hydromorphone ivp, then 0.5mg ivp q10min
Neuro problem: choose Fentanyl
Scott推薦在急診先用Propofol(Dexmedetomidine生效較慢)
Pain cannot be a “pressor”
RASS score
每月收聽的急診Podcast清單:
目前使用的android app.: AntennaPod http://antennapod.org/
由侯勝文醫師介紹Spinal Motion Restriction(譯為『脊椎減移』)
Introducing Spinal Motion Restriction into Taipei EMSS
P.S. 網頁可下載slides (.pdf)及影片(.wmv)