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Pocket Emergency Paediatric Care - part 8

Một cổ áo cứng một cách chính xác phù hợp, hỗ trợ phụ, và ngăn chặn đầu sau đó duy trì cố định cho đến khi cột sống xóa. Hướng dẫn sử dụng phương pháp in-line trở lại nếu đường hàng không diễn tập như đặt nội khí quản. Bình thường x quang không loại trừ tổn thương tủy sống. | TRAUMA AND SURGICAL 139 A correctly fitting hard collar side-supports and head blocks then maintain immobilisation until spine cleared. Manual in-line method resumed if airway manoeuvres such as intubation. Normal x rays do not exclude spinal cord injury. Signs of airway obstruction Rapid rate Noisy breathing total obstruction may be silent Recession paradoxical breathing Cyanosis Agitation or drowsiness Decreased or absent breath sounds on auscultation. The airway should be cleared of debris and careful jaw thrust applied. If no improvement oropharyngeal airway inserted. If still obstructed orotracheal intubation under direct vision with manual in-line stabilisation of the cervical spine Pre-oxygenation with 100 oxygen with manual lung inflation if required Administration of a carefully judged reduced dose of an anaesthetic induction agent Application of cricoid pressure Suxamethonium 1-2 mg kg Intubation with a correctly sized tracheal tube Replacement of the collar and blocks after confirming tube placement and relaxing cricoid pressure. Confirmation of correct placement of the tube Most important see tube pass through vocal cords. The correct size is tube placed easily through cords with small leak. Place tube 2-3 cm below cords and note length at teeth before check by auscultation. If orotracheal intubation not possible needle cricothyroidotomy or in 11 years surgical cricothyroidotomy. 140 POCKET EMERGENCY PAEDIATRIC CARE Breathing - assessment of adequacy of respiration Rate Chest expansion Recession Use of accessory muscles Nasal flaring Inspiratory or expiratory noises Breath sounds Heart rate Colour Mental state Pulse oximetry Examine trachea neck veins and chest for pleural collections of air or blood. Tension pneumothorax treated immediately with needle thoracocentesis in 2nd intercostal space on affected side in midclavicular line followed by tube thoracostomy. Circulatory assessment Capillary refill Skin colour Temperature Systolic blood pressure .