急诊清醒患者麻醉诱导气管插管62例的护理配合

目的探讨急诊清醒患者麻醉诱导气管插管时的护理配合。方法从气管插管物品准备、患者监护及准备、麻醉诱导气管插管期间与麻醉医生的护理配合等方面,总结了62例急诊清醒患者麻醉诱导气管插管的护理和体会。结果采取相应护理配合,62例气管插管均插管成功。结论在急诊清醒患者麻醉诱导气管插管时,护理配合应做到物品准备齐全,监测完善,与麻醉医生密切合作。     

6例肥胖患者气管插管术的护理

目的：：分析6例肥胖患者气管插管术的护理,提出肥胖患者气管插管的护理方式总结和讨论。方法：对6例肥胖患者依据临床情况给予清醒气管插管方法和快速诱导后气管插管方法。结果：6例肥胖患者均顺利进行气管插管。结论：插管前充分的准备和气管插管时护士熟练的护理配合,保证了患者全身麻醉气管插管顺利完成。     

爱可松用于全麻气管插管的临床体会

爱可松是一种新型非去极化氨基甾类肌松药，其显著特点是起效快速，给予正常气管插管剂量时便可迅速产生优良的气管插管条件。2007年我院对30例患者采用麻醉快速诱导，使用爱可松气管插管体会报告如下：     

麻醉诱导后不同剂量利多卡因气管内喷注对气管插管心血管应激反应的影响

目的分析麻醉诱导后气管内喷注不同剂量利多卡因对气管插管时心血管应激反应的影响。方法将接受全身麻醉手术治疗的75例患者随机分为A、B及C三组,每组25例。其中A组麻醉诱导后不喷注利多卡因,B组麻醉诱导后喷注2%利多卡因1 ml,C组麻醉诱导后喷2%注利多卡因3 ml。对比三组气管插管过程中心率(HR)、收缩压(SBP)、舒张压(DBP)及肾上腺素浓度(COR)变化情况。结果三组治疗前后各时间点HR、SBP、DBP及COR比较,均呈降低后升高再降低趋势;而诱导前及诱导后3 min三组HR、SBP、DBP及COR比较,差异未见统计学意义(P0.05),插管后3 min、6 min,HR、SBP、DBP、COR A组最高,C组最低,差异有统计学意义(P0.05)。结论在麻醉诱导后气管内喷注2%注利多卡因3 ml可有效的降低气管插管时的心血管应激反应。     

经口鼻换管气管插管行口腔颌面外伤手术麻醉处理15例分析

口腔颌面外伤急诊手术，由于手术部位影响及病情的需要，在全麻诱导气管插管处理上有其特殊性，处理不当可危及患者生命。我院采用经口与经鼻换管气管插管行口腔颌面外伤手术麻醉处理15例，临床效果满意，现介绍分析如下。     

感染性休克患者的麻醉处理

目的：回顾分析20例感染性休克患者的麻醉处理,报告心得体会。方法：入室后建立静脉通道,并进行全面监测,然后进行全麻诱导,快速气管插管;术中维持麻醉,并同步抗休克;术后将患者送ICU继续抗休克治疗。结果：20例患者中,17例术后明显好转,送ICU继续抗休克治疗;3例病情加重,于术后几小时死亡。结论：感染性休克手术一般选用气管插管全身麻醉为佳,麻醉应选择对循环抑制较轻的药物,手术同时全面监测各项相关指标,积极进行抗休克治疗。     

气管插管前一种快速药物诱导技术

快速有效的药物诱导技术(KSI)是气管插管时应用的一种技术。其特点是在没有正压通气的情况下进行气管插管，可有效减轻病人的痛苦。KSI技术包括麻醉前用药、麻醉诱导。     

七氟烷在小儿困难气管插管中的应用

【目的】观察七氟烷在小儿困难气管插管中的应用。【方法】选择2009年来我院行择期或急诊手术且存在困难气道的165例患儿为研究对象,采用面罩吸入8％七氟烷复合氧气（4～6L／min）诱导插管,观察在全麻诱导前（T1）、气管插管前（T2）、插管时（T3）、插管后3min（T4）及四个不同时段患儿平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）及不良事件发生率。【结果】全组惠儿麻醉诱导和气管插管期间均未发生明显低氧血症,麻醉诱导平稳,呼吸、心率、血压均能维持在正常范围。【结论】采用8％七氟烷吸入麻醉诱导可以减少小儿困难气管插管中气管插管的风险,且不良反应少。     

气管插管在肺部疾病复苏的临床价值

目的：分析急诊肺部疾病心搏呼吸骤停的特点、病因及复苏中采用早期气管插管,对46例患者抢救的成功率、存活率以及影响预后的相关因素.方法：采用早期气管插管及相应的复苏措施,对临床资料进行分析.结果：46例复苏成功40例,占86.95%;存活出院22例,占47.82%;（脑复苏成功20例,占43.48%）.经统计学处理,复苏成功与否与复苏开始时间及气管插管时间有关.结论：慢性呼衰急性发作、支气管哮喘、肺栓塞是其主要原因.复苏开始的时间、气管插管时间是影响急诊复苏成功率及预后的主要因素.     

快诱导经口盲探气管内插管120例分析

目的研究一种新的气管内插管法—快诱导经口盲探插管法。方法选择需全麻手术患者120例,行麻醉快诱导后,不用喉镜根据人体解剖及体表标志并结合视、触行盲探气管内插管。结果盲探插管成功率达95%,第1次插管成功99例,第2次插管成功15例。结论此法类似光索插管法,但无需特殊设备及器材,可成功应用于临床麻醉的气管插管。     

Role of rapid sequence induction for intubation in the prehospital setting: helpful or harmful?

Use of rapid sequence induction for intubation was introduced to the prehospital environment in the hope of enhancing patient outcome by improving early definitive airway management. Varying success has been achieved in both air and ground transport emergency medical services systems, but concern persists about the potential to cause patients harm. Individual emergency medical services systems must determine the need for rapid sequence induction for intubation and their ability to implement a rapid sequence induction for intubation protocol effectively with minimal adverse events. Therefore, the value of rapid sequence induction for intubation is dependent on each emergency medical services system design in their ability to establish personnel requirements and ongoing training, expertise in airway management skills, medical direction and supervision, and a quality assurance program. If these principles are strictly adhered to, rapid sequence induction for intubation may be safely used as an advanced airway management technique in the prehospital setting.     

78例急诊创伤死亡病例回顾性分析及临床意义

目的：通过对急诊科创伤死亡病例的回顾性分析,探讨急救患者死亡的原因,为进一步加强急救网络医院急诊科内涵建设提供客观依据。方法：对我院2010-01-2012-12 78例急诊创伤死亡的病例填写调查表,用Profox6.0建立数据库,分析患者死亡年龄分布、致伤原因、抢救措施、出车时间,并采用SPSS l6.0软件进行统计学处理。结果：平均平均死亡年龄为44.8岁,以40~59岁年龄段最多。死亡原因依次为交通事故、高处坠落、重物砸伤、锐器伤、挤压伤。进行气管插管者占74.3%（58/78）,呼吸机维持呼吸者占80.7%（63/78）,实施胸外按压者占85.8%（67/78）。结论：急诊创伤死亡病例的年龄、致伤原因已发生明显变化。要重视院前死亡。监测和评估急诊科急救工作的时间因素、技术因素和质量因素等非常有必要,可依此加强管理。     

The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury

Objective: To determine the effects of rapid sequence intubation in patients with severe head injury performed by paramedics on a helicopter emergency medical service. Methods: The patient care records for patients with severe head injury who underwent rapid sequence intubation between November 1999 and February 2002 (inclusive) were examined. Data were extracted on the demographics of the patients, as well as the physiological changes before and after rapid sequence intubation. Results: There were 122 patients with severe head injury evaluated at the scene during the study period. Rapid sequence intubation was attempted in 110 patients and was successful in 107 (97%). Intubation was associated with improvements in systolic blood pressure, oxygen saturation and end‐tidal carbon dioxide levels, compared with baseline levels. Conclusion: Rapid sequence intubation in patients with severe head injury may be safely undertaken by helicopter‐based ambulance paramedics and is associated with improvements in oxygenation, ventilation and blood pressure. Further studies of this skill undertaken by road‐based paramedics are warranted.     

山西省急诊护士继续教育现状及需求调查

[目的]调查山西省急诊护士继续教育现状及需求,为更好地开展继续教育服务。[方法]采用便利抽样法,自设问卷对山西省11个地级市中92所医院共146名急诊急救专科护士进行问卷调查,了解急诊护士的一般情况、继续教育现状和需求。[结果]31.5%的急诊护士表示参加继续教育的频率在1年以上;56.2%的急诊护士通过短期培训班参加继续教育;69.2%的急诊护士认为工作繁忙影响他们参加继续教育;急诊护士对继续教育内容需求排在前5位的分别是：急救复苏相关技能、现场急救技能、创伤病人的急救护理、急危重症病人护理的相关理论知识和急诊各种抢救设备、物品及药物的应用和管理。[结论]急诊护士的继续教育需要加强;继续教育的内容应在学习急诊理论知识的同时注重培养护士抢救相关的实用技能。     

湖北地区医院静脉治疗护理管理现状调查与对策

目的:了解湖北地区医院静脉治疗护理管理现状。方法:对湖北地区49家医院的112名护士进行问卷调查。结果:①34家(69.4%)医院成立了静脉治疗组织,随着组织的不断健全,将逐渐实现常态化管理;33家医院(67.4%)将静脉治疗列入专项质量控制,由护理部与静脉治疗组织、科室共同管理,静脉治疗质量控制标准定位尚在探索中,专业化管理手段有待完善。②87名被调查者(77.7%)参加过静脉治疗相关培训,静脉治疗培训方式的多样化得到拓展,应尽快建立分层培训体系。③55名被调查者(49.1%)撰写过静脉治疗方面的护理论文,应加大专业领域研究力度,激发护士的科研意识。结论:湖北地区医院对静脉治疗护理管理、培训和研究高度重视,正向专业化、体系化、标准化的广度和深度推进,体现了静脉治疗专业管理方式与内涵的发展需求。     

Prehospital emergency rapid sequence induction of anaesthesia.

OBJECTIVE: To determine the number of and reasons for rapid sequence inductions done by accident and emergency (A&E) doctors out of hospital as part of the activities of the MEDIC 1 Flying Squad. "Rapid sequence induction" was defined as any attempted endotracheal intubation accompanied by use of drugs to assist intubation and ventilation, including opiates, benzodiazepines, intravenous and topical anaesthetics, and neuromuscular blocking drugs. METHODS: Retrospective study of all MEDIC 1 and A&E records over the period 1 February 1993 to 28 February 1996 (37 months). The anaesthetic technique used, drugs used, complications, difficulties, reasons for induction out of hospital, and grade of doctor performing the technique were determined. RESULTS: Various anaesthetic techniques were used to secure the airway definitively by endotracheal intubation. Several difficulties were encountered in the prehospital setting, all of which were dealt with successfully. CONCLUSIONS: The lack of complications related to rapid sequence induction in prehospital care suggests that this technique is safe when done by A&E doctors on appropriate patients.     

Emergency airway management--experience of a tertiary hospital in South-East Asia

OBJECTIVE: To study the indications and diagnoses of patients requiring emergency airway management and to evaluate the adequacy of airway management skills of emergency physicians. METHODS: Prospective observational study of all patients requiring advanced airway management from 1 November 1998 to 31 October 2002. RESULTS: There were 1068 cases, 710 (66.5%) were men. The median age was 63 years. The most common diagnoses requiring tracheal intubation were cardiopulmonary arrest (37.7%), congestive heart failure (20.8%) and head injury (8.3%). The main indications were apnoea (42.5%), hypoxia (21.3%) and prophylactic airway protection (17.6%). Orotracheal intubation with no medication was most common (51.5%) followed by rapid sequence induction (RSI) (28.4%) and orotracheal intubation with sedation only (19.6%). The overall success rate for orotracheal intubation was 99.6%. The cricothyrotomy rate was 0.2%. Hypotension (4.2%), multiple intubation attempts (1.9%) and oesophageal intubation (1.5%) were the three most common peri-intubation complications. There was no statistical difference in the occurrence of hypotension between the use of midazolam and etomidate for sedation or induction prior to intubation. Six hundred and forty-six (60.5%) patients survived the immediate post-resuscitation period. No patient died from failure to secure the airway. CONCLUSION: Airway management and rapid sequence induction for intubation can be safely performed by emergency physicians.     

Teaching rapid sequence intubation to pediatric emergency physicians: a pilot course

We describe and evaluate a pilot course designed to teach rapid sequence intubation (RSI) to pediatric emergency physicians. A questionnaire was utilized to assess participants' self-assessment of knowledge and skills in defined areas related to rapid sequence intubation, before and after the course. Thirteen pediatric emergency physicians (nine attendings and four fellows) participated in the pilot course. A significant increase in self-assessment of knowledge and skills was found after the course for most parameters analyzed. These areas included: knowledge of indications and contraindications for RSI, knowledge of specific sedating and paralyzing agents, knowledge of complications of RSI and their management, and level of comfort performing RSI when indicated (P < 0.05). We conclude that a formal course can significantly enhance self-assessment concerning ability to perform rapid sequence intubation. Further study is required to determine if such a course improves performance of this procedure.     

Underdosing of Midazolam in Emergency Endotracheal Intubation

OBJECTIVES: To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid-sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents. METHODS: The authors conducted a systematic query of a prospectively collected database of ED intubations using the National Emergency Airway Registry data, gathered in 11 participating EDs over a 16-month period. A data form completed at the time of emergency department intubation (EDI) enabled analysis of patients' ages, weights, and indications for EDI, as well as the techniques and drugs used to facilitate EDI. Data were analyzed to determine whether midazolam is used in recommended doses during RSI. Patients intubated with midazolam alone were compared with patients who received other induction agents for RSI. RESULTS: Of 1,288 patients entered in the study, 1,023 (79%) underwent RSI. Of the 888 RSI patients with an age recorded, midazolam was used as the sole induction agent in 140 (16%). The mean (+/-SD) dosages of midazolam used in RSI were 2.6 (+/-1.7) mg in children (age < or = 18) and 3.7 (+/-2.5) mg in adults (age > or =19); the mean (+/-SD) dosages by weight were 0.08 (+/-0.04) mg/kg in children and 0.05 (+/-0.03) mg/kg in adults. More than half (56%) of the children, and nearly all (92%) of the adults, received dosages lower than the minimum recommended dosage (0.1 mg/kg). Of patients who received barbiturates, only 21% of children and 21% of adults received a dose lower than the minimum recommended. When combined with another induction agent, midazolam was dosed similarly to when it was used alone: mean adult doses were 3.1 (+/-1.2) mg and 0.04 (+/-0.02) mg/kg. CONCLUSIONS: Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used.     

Rocuronium vs. Succinylcholine in the Emergency Department: A Critical Appraisal

Background: Two methods of paralysis are available for rapid sequence intubation (RSI) in the emergency department (ED): depolarizing agents such as succinylcholine, and non-depolarizing drugs such as rocuronium. Rocuronium is a useful alternative when succinylcholine is contraindicated. Contraindications to succinylcholine include allergy, history of malignant hyperthermia, denervation syndromes, and patients who are 24–48 h post burn or crush injury. Non-depolarizing drugs have the advantage of causing less pain due to post-paralysis myalgias. Clinical Question: Can rocuronium replace succinylcholine as the paralytic of choice for RSI in the ED? Evidence Review: Four relevant studies were selected from an evidence search and a structured review performed. Results: For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents were not statistically significantly different. Succinylcholine seems to produce conditions that have higher satisfaction scores. Conclusion: Succinylcholine remains the drug of choice for ED RSI unless there is a contraindication to its usage.