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急诊气道管理共识(2016)

2016-07-08 中华重症医学电子杂志 中华重症医学电子杂志

气道管理是急诊医师的基本技能,是维持急危重症患者生命体征的重要手段。虽然中华医学会麻醉学分会在2013年推出了我国的《困难气道管理指南》,但对于急诊患者,存在病种、病情、治疗环境等多方面的差别,无法有效指导急诊临床实践。中国急诊气道管理协作组结合急诊气道管理的特点,提出“优先维持通气与氧合,快速评估再干预,强化降阶梯预案,简便、有效、最小创伤”为原则的急诊气道管理专家共识。协助急诊医师及相关从业人

气道管理是急诊医师的基本技能,是维持急危重症患者生命体征的重要手段。虽然中华医学会麻醉学分会在2013年推出了我国的《困难气道管理指南》,但对于急诊患者,存在病种、病情、治疗环境等多方面的差别,无法有效指导急诊临床实践。中国急诊气道管理协作组结合急诊气道管理的特点,提出“优先维持通气与氧合,快速评估再干预,强化降阶梯预案,简便、有效、最小创伤”为原则的急诊气道管理专家共识。协助急诊医师及相关从业人员掌握规范、高效的气道管理流程,提高急诊气道管理的质量。

急诊气道管理可分为两个步骤

第一步1确保通气与氧合,同时初步评估气道情况。保证患者生命安全为首要 目标。同时按“CHANNEL原则”初步评估患者气道情况 。

第二步1明确气道情况,建立人工气道。这一阶段明确患者气道情况,按 照“降阶梯”的思路进行准备,建议使用气道管理车,以提供立即可取的气道管理设备,迅速建立人工气道。有条件的患者可选择 快速诱导插管程序。遇到困难气道时,遵循“优先维持通气与氧合”原则,切忌盲目多次尝试。人工气道的建立方式遵循“简便 、有效、最小创伤”原则,优选可视化技术。详见急诊气道管理 临床决策流程(见图1) 。





图1 急诊气道管理临床决策流程

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  1. [GetPortalCommentsPageByObjectIdResponse(id=130268, encodeId=e2b5130268cb, content=不错哦继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 18 15:28:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92840, encodeId=255e92840ab, content=看不清图, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Tue Jul 12 16:01:00 CST 2016, time=2016-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393941, encodeId=b34f139394110, content=<a href='/topic/show?id=ddb96388638' target=_blank style='color:#2F92EE;'>#气道管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63886, encryptionId=ddb96388638, topicName=气道管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Sun Jul 10 02:36:00 CST 2016, time=2016-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92361, encodeId=e63892361f4, content=流程图看不清啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160229/IMG56D321252C0101765.jpg, createdBy=e2381693259, createdName=Janine 9795, createdTime=Fri Jul 08 13:00:00 CST 2016, time=2016-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92360, encodeId=d64292360f0, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160604/IMG57523622BFC784441.jpg, createdBy=669d1732453, createdName=进击的叶子酱, createdTime=Fri Jul 08 12:45:00 CST 2016, time=2016-07-08, status=1, ipAttribution=)]
    2016-09-18 1e10c84am36(暂无匿称)

    不错哦继续关注

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=130268, encodeId=e2b5130268cb, content=不错哦继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 18 15:28:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92840, encodeId=255e92840ab, content=看不清图, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Tue Jul 12 16:01:00 CST 2016, time=2016-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393941, encodeId=b34f139394110, content=<a href='/topic/show?id=ddb96388638' target=_blank style='color:#2F92EE;'>#气道管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63886, encryptionId=ddb96388638, topicName=气道管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Sun Jul 10 02:36:00 CST 2016, time=2016-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92361, encodeId=e63892361f4, content=流程图看不清啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160229/IMG56D321252C0101765.jpg, createdBy=e2381693259, createdName=Janine 9795, createdTime=Fri Jul 08 13:00:00 CST 2016, time=2016-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92360, encodeId=d64292360f0, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160604/IMG57523622BFC784441.jpg, createdBy=669d1732453, createdName=进击的叶子酱, createdTime=Fri Jul 08 12:45:00 CST 2016, time=2016-07-08, status=1, ipAttribution=)]
    2016-07-12 黑心天使

    看不清图

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=130268, encodeId=e2b5130268cb, content=不错哦继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 18 15:28:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92840, encodeId=255e92840ab, content=看不清图, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Tue Jul 12 16:01:00 CST 2016, time=2016-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393941, encodeId=b34f139394110, content=<a href='/topic/show?id=ddb96388638' target=_blank style='color:#2F92EE;'>#气道管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63886, encryptionId=ddb96388638, topicName=气道管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Sun Jul 10 02:36:00 CST 2016, time=2016-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92361, encodeId=e63892361f4, content=流程图看不清啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160229/IMG56D321252C0101765.jpg, createdBy=e2381693259, createdName=Janine 9795, createdTime=Fri Jul 08 13:00:00 CST 2016, time=2016-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92360, encodeId=d64292360f0, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160604/IMG57523622BFC784441.jpg, createdBy=669d1732453, createdName=进击的叶子酱, createdTime=Fri Jul 08 12:45:00 CST 2016, time=2016-07-08, status=1, ipAttribution=)]
    2016-07-08 Janine 9795

    流程图看不清啦

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=130268, encodeId=e2b5130268cb, content=不错哦继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 18 15:28:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92840, encodeId=255e92840ab, content=看不清图, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9ebb1716792, createdName=黑心天使, createdTime=Tue Jul 12 16:01:00 CST 2016, time=2016-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393941, encodeId=b34f139394110, content=<a href='/topic/show?id=ddb96388638' target=_blank style='color:#2F92EE;'>#气道管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63886, encryptionId=ddb96388638, topicName=气道管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=198d2500149, createdName=12498bd5m16暂无昵称, createdTime=Sun Jul 10 02:36:00 CST 2016, time=2016-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92361, encodeId=e63892361f4, content=流程图看不清啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160229/IMG56D321252C0101765.jpg, createdBy=e2381693259, createdName=Janine 9795, createdTime=Fri Jul 08 13:00:00 CST 2016, time=2016-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=92360, encodeId=d64292360f0, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160604/IMG57523622BFC784441.jpg, createdBy=669d1732453, createdName=进击的叶子酱, createdTime=Fri Jul 08 12:45:00 CST 2016, time=2016-07-08, status=1, ipAttribution=)]
    2016-07-08 进击的叶子酱

    ?学习了

    0

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