中医中药学案例外文版 (9).pdf

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1、Hello everyone.I am Wang Qiang from The First Affiliated Hospital of Xian Jiaotong University.It is my honor to share with you this topic,titled Recommended Practice Procedures of Endotracheal Intubation and Infection Prevention for Patient with COVID-19.This topic will be presented by the following

2、 aspects.Since COVID-19 has spread rapidly throughout the globe.Most clinical manifestations observed have revealed mild to severe respiratory symptoms.Endotracheal intubation is necessary for emergency treatment along with administration of general anesthesia for patients infected with COVID-19.How

3、ever,it also puts anesthesiologist a high risk of no infections as a result direct contact with the patients airway.The indications endotracheal intubation will be needed or patients on the emergency treatment.Such as severe hypoxemia,requiring invasive ventilation and emergency resuscitation.And th

4、e patients who need surgery under general anesthesia.Emergency Endotracheal Intubation When receiving calls from the isolated ward,we should obtain all pertinent patient information and instruct the supervising physician to make related preparations.And experienced anesthesiologist with an assistant

5、 prepares and carries emergency intubation supplies and anesthetics to the ward and performs the intubation.Before entering the ward they should carry out tertiary protections with correct medical protective supplies both in the clean area and semi contaminated area,according to the relevant guideli

6、nes.When arriving at the isolated ward,they must check patient information,assess the patients general condition,and performed rapid assessment of the airways.Then the anesthesiologist should optimize the physical position of the patient,such as removing the headboard and keeping them in a supine po

7、sition.If patients are assessed to have none difficult airways or a trick you intubation will be performed by visual laryngoscope.Firstly they supply sufficient preoxygenation according to the following procedures.Make patients wear surgical masks,connect the face mask with a respirator balloon with

8、 the artificial filter,supply sufficient oxygen with BiPAP or respirator mask.Then they successively give rapid induction anesthetics as following.Intravenous injection of two to five milligrams of midazolam combined with etomidate or propofol for deep sedation.After unconsciousness is achieved,inje

9、ct one milligram per kilogram of rocuronium for enough muscle relaxation and then inject about two micrograms of sufetanil.Finally after the muscle relaxant is fully effective,quickly insert the endotracheal tube into the trachea using visual laryngoscope.Connect the ventilator with filter,adjust ve

10、ntilator parameters.Check and expiratory carbon dioxide waveform to confirm the tube into the trachea.According to tertiary protection guidelines is not convenient to perform osculation and should make a comprehensive judgment of the endotracheal tube depth by the distance of tracheal tube from bila

11、teral chest undulation,ventilator waveform,ultrasonography,fiber bronchoscope,etc.If intubation fails,they will immediately provide pressurized oxygen with a ventilator mask.When oxygenation is improved,they should optimize the airway management strategy according to the principles of difficult airw

12、ay intubation.After endotracheal intubation,they then adjust respiratory parameters following the lung protective ventilation strategy.Low tidal volume four to eight milligrams per kilogram.Plateau pressures less than or equal to 30 mm H2O.Inspired oxygen fraction less than 60%.PEEP five to eight cm

13、 H2O and three to five times per hour of recruitment maneuver.Then dispose of intubation items are medical protective gears according to the rules.Endotracheal Information under General Anesthesia.The minus 5 pa of negative pressure of air conditioning purification system in operating room should be

14、 prepared first.To anesthesiologist wearing tertiary protective equipment take sufficient anesthetics and supplies into the operating room.All members and supplies follow the one-way flow principle.The anaesthetic machine is connected with three breath filters.The anesthesiologist evaluates the pati

15、ent by phone,video,etc.For patients with difficult airways,anesthesiologist prepare related apparatus,supplies a multidisciplinary personnel according to the principles of anticipated difficult airway intubation.After all the preparations are complete,anesthesiologist enter the operation room,check

16、the patient again,evaluate the patients cardiopulmonary function etc.The patient wears a mask and in hales high flow pure oxygen.Rapid induction is performed by anesthetic titration in the same manner as the above emergency endotracheal interpretation guidelines.Then anesthesiologist performed tract

17、 intubation fixation and depth judgment.According to the principles of unanticipated difficult airway intubation.If intubation fails,anesthesiologist should call for help and apply a second generation laryngeal mask.If both fail,immediately establish invasive ventilation through the cricothyroid mem

18、brane.Monitor vital signs closely.Individualized fluid replacement and maintain stable circulation.Apply lung protective ventilation strategy.Review blood gas levels,adjust oxygenation index and internal environment.Sufficient analgesia and inhibition of choking are indispensable for extubation.Resp

19、iratory secretion is cleared under deep anesthesia.When breathing is fully restored but sedation is not restored,extubation is performed with a filter at the end.If the patient safety cannot be ensured,the patients with mild symptoms are extubated only once fully awake and the severe cases are taken

20、 to the ICU with an endotracheal tube.After the surgery,call the operating room front desk staff to open the specified transit route.Transfer personnel replace secondary protection.Cover the patients entire body with a single surgical procedure.Endotracheal intubation period disinfection is equally

21、important Disposable items such as external tubing of the anesthesia machine,laryngeal scopes,anesthesia masks etc,are sealed with double layered medical garbage bags and marked with the COVID-19 logo and are specially disposed of by professional persons.The surface of the equipment should be wiped

22、and disaffected with 1000 milligram per liter chlorine disinfectant twice.If it is not resistant to corrosion,use 75%ethanol for disinfection.For visible pollution,clean up visible debris using disposable absorbent material,cover with 2000 milligrams per liter chlorine-containing disinfectant cloth

23、for 30 minutes and then wipe.The anesthesia machine should be sterilized by connecting the loop of the compound alcohol sterilizer or sterilizer the inner tubing.For sterilization of the operation room,spray with peroxyacetic acid,hydrogen peroxide and keep the operation room closed for two hours.Tu

24、rn on laminar flow and ventilation and keep the operation room closed for at least two hours.In summary When performing emergency intubation in the outside of operating room,carry sufficient emergency intubation items and drugs.Apply tertiary protective gears,evaluate the patients airway difficultie

25、s fully and lastly choose the optimal intubation scheme to avoid being caught off guard.When implementing general anesthesia intubation,setup specified transit route,use a negative pressure operating room,pay attention to difficult airway management and critically ill patients respiratory and circulation management,use sufficient analgesia and inhibition of choking for extubation,ensure secondary protective gears are used during transfer.During the epidemic I hope every doctor can protect himself and help more patience.Thank you.