tips&tricks in der supraglottischen atemwegesicherung · tips&tricks in der...
TRANSCRIPT
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Tips&Tricks in der supraglottischen
unerwarteten
schwierigen
Atemwegesicherung
Karel Pelikan
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Patronem
této
prezentace
je svatý
Blažej, svatý
patron hrdla
a všech
hračiček, co
se do něj v
dobré víře
ve snaze
zachránit
život
strkaj…
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KDYŽ SI CHLAPEČCI HRAJÍ,
(se svýma hračičkama)
ŇIKDY NEZLOBÍ!!!
Tumáš!!!Mazánku!!! Sladkou smetánku!!!!!!!!!!!!!!! Fr. Nicci
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Tu máš,
mazánku,
sladkou
smetánku…
(Café Melange)
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Osobitým přístupem plynule navázal dr. Pelikán a
začal svoji přednášku Supraglotické zajištění
dýchacích cest – laryngeální maska svým
oblíbeným život zachraňujícím výkonem jaw thrust
……………..……………….. Posluchači během
přednášky posílili své bránice jako každý
rok…………..
http://www.akutne.cz/index.php?pg=sestra&aid=632
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JAW THRUST
Angl.kecy, sanice ,líčko ,tlama, sevřít
huba,čelist,tah
Základní život zachraňující úkon
A proto „In THRUST we trust“(L.Dinner-Večeřa)
Trust angl. věřit ,důvěra, víra
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JAW THRUST
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JAW THRUST sec. Jarda Duchoň
Základní život zachraňující úkon
Ve válečném poli, terénu(ordinace) – bezvědomí, nedýchá,oslovit!
Zakleknout za hlavu sevřít ji mimo uši
Uchopit dolní čelist otevřít zvednout
Současně aplikujeme tlak za uši-bolí!!!
ideální monitoring GCS
Pokud pac. Nereaguje,je to zlé!!!!!!!!!
Jeho užití je sexy!
Brání panice,“něco se děje“ holywood
Jaw thrust zklidňuje zachránce,
máme situaci pod kontrolou
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Jaw thrust na operačním
sále
Aplikace po uspání-kontrola hloubky
anest
Pokud reaguje – fšechno
špatně!!!ukousne prst
Přidat narkosu až nereaguje
Na konci operace – zkouška kdy už se
bude budit
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Vyšší level Jaw thrust
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JAW
THRUST
JE
SEXY
!!!
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Who is who? First Lieutenant (and later
Captain) in the U.S. Army
from 1917-1919. During his
time, he worked at the
American Expeditionary
Forces hospitals in Chaumont
and Vittels, France. He was
responsible for overseeing up
to six hospitals at one time.
For this reason, he became
known as the "motorcycle
anesthetist" because he would
travel to the various hospitals
by motorcycle.
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Není to dědeček Luboše
Večeři…
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Arthur Ernest
Guedel (June 13, 1883 – June 10, 1956)
was an American anesthesiologist. He was
known for his studies on the uptake and
distribution of inhalational anesthetics, as
well for defining the various stages of
general anesthesia (Guedel's
classification)
The guedel pattern
airway is named after
him…
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The guedel pattern airway
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The guedel pattern airway
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The guedel pattern airway
Nestyď se jej použít – vyřeší jednodušše can not ventilate
Pomni přetlak max. 20 cm H2O při ambuingu!!!
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DAM
Difficult airway management
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The LMA™ in a
EASIEST difficult
airway algorithm
Gilles Dhonneur
Professor of Anesthesiology and Intensive Care Medicine
Jean Verdier University Hospital of Paris, Bondy
Paris XIII University, Bobigny School of Medicine
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Gilles EASIEST Algorithm
(unexpected DAM in OR) Induction
Facemask ventilation
+ Difficult
Scenario 2
Tracheal Intubation (OTI)
+ -
+
Gum Elastic Bougie
Direct laryngoscopy OTI
+ -
LMA Fastrach
Supreme,ProSeal
Step 1
Step 2
Impossible
Scenario 1
Ventilation/Oxygenation (V/0)
Step 1
-
Trans -TrachealV/O
+
Rescue LMA Fastrach V/O
LMA Supreme-
Step 2
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Archie Brain (vynálezce LMA) :
“užití laryngeální masky v
elektivní operativě místo rutinní
tracheální intubace je nejlepším
tréninkem planu B v DAM“
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LMAclassic, ILMA, LMAunique, LMAflexible,
ProSeal
LMA Family
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ProSeal
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ProSealTM
LMA – Gastric Access
Gastric drain tube u LMA ProSealTM (2000) a LMA SupremeTM (2006)
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The LMA ProSeal™
1ST LMA™ with Gastric Access
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4 principy ProSealTM
LMA
• Seal with the respiratory tract
• Conduit to the respiratory tract
• Seal with the GIT
• Conduit to the GIT
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Seal with the respiratory tract
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Seal with the respiratory tract
Malpozice I. Aspirační riziko 1
Distální manžeta v oropharyngu - není těsnost s respiračním a GIT.
Co hrozí: Aspirace, obstrukce - epiglottis v dutině LMA, inflace žaludku
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Seal with the respiratory tract
Malpozice II. - aspirační riziko 2
Malpozice „folding over cuff“ znemožňuje zavedení sondy díky
zalomení gastric drain tube v orofaryngu.
V anesteziologii patří mezi nejzákeřnější malpozice
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Trénuj LMA Fastrach(C-Trach, Supreme,ProSeal… etc. na sále!!!
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Seal with the GIT
Antiaspiration strategy by occlusion
Antiaspiration strategy with drainage of the stomach
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Conduit with the GIT
A. Schema umístění sondy v gastric drain tube LMA ProSealTM
B. Zavádění sondy skrze gastric drain tube LMA ProSealTM
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Gastric Content Management
In any moment during the
operation It will be possible to
pass an O.G. tube thru the
drain tube to manage the
gastric content avoiding the
risk of regurgitation and
aspiration.
Gastric Access increase the
safety for the patient!!!
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Gastric Content Management
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Integral bite block
Unique elliptical airway tube
Easy placement
Stable airway in situ
No kink
Fixation tab
Ensures tip engagement with UOS
Easy fixation
Larger Pre-curved cuff
Ensuring laryngeal fit and effective seal
Larger cuff for improved seal
Epiglottic fins
Prevent epiglottis entering airway
Reinforced tip over moulded distal cuff
prevent fold over
LMA Supreme™ - Features
Summary
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Contour of Airway Tube
to Backplate optimized
for easy insertion
Design – insertion success
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The LMA Supreme™ Insertion
LMA Supreme™ Insertion technique imitates the physiological deglution movement and
It is the key for the good performance of LMA.
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The LMA SUPREME ™ Evolution
Curve™ The Supreme LMA
Evolution Curve™ is
designed to be rigid
enough to facilitate
successful insertion
and supports
anatomical
conformity therefore
suitable for surgical
interventions >2hrs The Supreme LMA Evolution Curve™ is protected by a series of granted and pending patents,
each covering a distinctly unique invention
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The LMA SUPREME ™ - Cuff Larger preformed cuff curvature
Reliable Seal at all times
Optimal for:
Obesity, Reflux, PPV,Longer Procedures,
Patient Position, Intra abdominal
Airway size Max. Inflation Vol.
3 30ml
4 45ml
5 45ml
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LMA SUPREME ™ – DAM In
Obesity
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LMA SUPREME ™ – Lateral
Position
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![Page 52: Tips&Tricks in der supraglottischen Atemwegesicherung · Tips&Tricks in der supraglottischen ... Supreme,ProSeal Step 1 Step 2 Impossible ... Gastric drain tube u LMA ProSeal TM (2000)](https://reader030.vdocuments.mx/reader030/viewer/2022012919/5ade988c7f8b9a8f298bcd06/html5/thumbnails/52.jpg)
![Page 53: Tips&Tricks in der supraglottischen Atemwegesicherung · Tips&Tricks in der supraglottischen ... Supreme,ProSeal Step 1 Step 2 Impossible ... Gastric drain tube u LMA ProSeal TM (2000)](https://reader030.vdocuments.mx/reader030/viewer/2022012919/5ade988c7f8b9a8f298bcd06/html5/thumbnails/53.jpg)
Děkuji za trpělivost…
![Page 54: Tips&Tricks in der supraglottischen Atemwegesicherung · Tips&Tricks in der supraglottischen ... Supreme,ProSeal Step 1 Step 2 Impossible ... Gastric drain tube u LMA ProSeal TM (2000)](https://reader030.vdocuments.mx/reader030/viewer/2022012919/5ade988c7f8b9a8f298bcd06/html5/thumbnails/54.jpg)
A na úplný závěr
ještě jeden prakticý tip:
NEPODCEŇUJ SPRÁVNÉ OBUTÍ
![Page 55: Tips&Tricks in der supraglottischen Atemwegesicherung · Tips&Tricks in der supraglottischen ... Supreme,ProSeal Step 1 Step 2 Impossible ... Gastric drain tube u LMA ProSeal TM (2000)](https://reader030.vdocuments.mx/reader030/viewer/2022012919/5ade988c7f8b9a8f298bcd06/html5/thumbnails/55.jpg)
Tato prezentace nebyla sponzorována společností
![Page 56: Tips&Tricks in der supraglottischen Atemwegesicherung · Tips&Tricks in der supraglottischen ... Supreme,ProSeal Step 1 Step 2 Impossible ... Gastric drain tube u LMA ProSeal TM (2000)](https://reader030.vdocuments.mx/reader030/viewer/2022012919/5ade988c7f8b9a8f298bcd06/html5/thumbnails/56.jpg)