Intubatia orotraheala Introducera unui tub special prin cavitatea bucala in

trahehee

-

-

-

-

- nlesnirea toaletei bronhice.

- administrarea unor droguri ca: adrenalina, atropina,

xilina.

Examenul preanestezic(II)

B. Examenul clinic al pacientului

Examen general

Focus :

Cai respiratorii (IOT);

Capital venos;

Conformatia coloanei (ALR).

Arsuri

Trauma

faciala

Antec

anafilaxie

Stridor

Corp strain

Obez / pitic

Gat scurt muscular

Piept mare/ lat

Retrognatie (Dentures)

Dinti de cal - incisiviii (Buck Teeth)

http://www.iacuc.arizona.edu/training/cats/medicating.htmlhttp://www.iacuc.arizona.edu/training/cats/medicating.htmlhttp://images.google.ro/imgres?imgurl=http://www.aafp.org/afp/20040201/525_f5.jpg&imgrefurl=http://www.aafp.org/afp/20040201/561.html&h=235&w=300&sz=11&hl=ro&start=8&tbnid=HK31V97NwHn0TM:&tbnh=91&tbnw=116&prev=/images%3Fq%3Dreceding%2Bjaw%26gbv%3D2%26svnum%3D10%26hl%3Dro%26sa%3DGhttp://images.google.ro/imgres?imgurl=http://www.wolfram.demon.co.uk/godofos.jpg&imgrefurl=http://www.wolfram.demon.co.uk/rp_am_wo_dolf.html&h=395&w=276&sz=11&hl=ro&start=14&tbnid=crA23q1VF6z9lM:&tbnh=124&tbnw=87&prev=/images%3Fq%3DShort%2BMuscular%2Bneck%26gbv%3D2%26svnum%3D10%26hl%3Dro%26sa%3DGhttp://images.google.ro/imgres?imgurl=http://www.thebca.org/stdpix/p8_1.gif&imgrefurl=http://www.thebca.org/ilstd.html&h=161&w=260&sz=14&hl=ro&start=75&tbnid=9GUxC3CCWyjtxM:&tbnh=69&tbnw=112&prev=/images%3Fq%3DShort%2BMuscular%2Bneck%26start%3D60%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Dro%26sa%3DNhttp://images.google.ro/imgres?imgurl=http://www.fugly.com/media/IMAGES/Babes/ridiculously_large_breasts.jpg&imgrefurl=http://www.fugly.com/images/11917/ridiculously_large_breasts.html&h=604&w=450&sz=42&hl=ro&start=2&tbnid=-TGrM68a5eYb_M:&tbnh=135&tbnw=101&prev=/images%3Fq%3Dlarge%2Bbreasts%26gbv%3D2%26svnum%3D10%26hl%3Drohttp://images.google.com/imgres?imgurl=http://www.cpr.org.tw/heart/image/baby_FBAO08.jpg&imgrefurl=http://www.cpr.org.tw/heart/heart_3.htm&h=640&w=480&sz=45&hl=ro&start=1&sig2=skZ8-goK-Ae2ljbZbAeU_A&um=1&tbnid=XSDjFQBlNhiLSM:&tbnh=137&tbnw=103&ei=6qpQRvqEPJeK-gKXjc2MDQ&prev=/images%3Fq%3DFBAO%26svnum%3D10%26um%3D1%26hl%3Dro%26sa%3DN

> 3 degete de la falca la gat

Falca mai lata de 3 degete

Deschide gura > 2 degete

3- Fingers Mouth Opening 3- Fingers Hypomental Distance.

3Fingers between the tip of the jaw and the

beginning of the neck (under the chin)

2- fingers between the thyroid notch and

the floor of the mandible (top of the neck)

1- Finger Lower Jaw Anterior sublaxation

http://images.google.ro/imgres?imgurl=http://www1.istockphoto.com/file_thumbview_approve/300759/2/istockphoto_300759_tongue_trick.jpg&imgrefurl=http://www.istockphoto.com/imageindex/300/7/300759/Tongue_Trick.html&h=253&w=380&sz=29&hl=ro&start=92&tbnid=2uMThNGYuwag-M:&tbnh=82&tbnw=123&prev=/images%3Fq%3Dopen%2Bthe%2Bmouth%2B%2B%26start%3D80%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Dro%26sa%3DNhttp://images.google.ro/imgres?imgurl=http://neverendingjoy.com/test1/nfblog/wp-content/uploads/Hippo2.JPG&imgrefurl=http://neverendingjoy.com/test1/nfblog/&h=339&w=508&sz=36&hl=ro&start=87&tbnid=GZ3PDvf1gR6jeM:&tbnh=87&tbnw=131&prev=/images%3Fq%3Dopen%2Bthe%2Bmouth%2B%2B%26start%3D80%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Dro%26sa%3DNhttp://images.google.ro/imgres?imgurl=http://www.davidgardiner.net/3fingers_vs.jpg&imgrefurl=http://www.davidgardiner.net/chameleon.html&h=298&w=549&sz=34&hl=ro&start=6&tbnid=-JXMZzQJ97v0QM:&tbnh=72&tbnw=133&prev=/images%3Fq%3Dthree%2Bfingers%26gbv%3D2%26svnum%3D10%26hl%3Dro%26sa%3DGhttp://images.google.ro/imgres?imgurl=http://www.theinterpretersfriend.com/terp4/alif-baa/thaa.jpg&imgrefurl=http://www.theinterpretersfriend.com/terp4/Arabic.html&h=396&w=545&sz=16&hl=ro&start=59&tbnid=Lzq5o1JideCyGM:&tbnh=97&tbnw=133&prev=/images%3Fq%3Dthree%2Bfingers%26start%3D40%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Dro%26sa%3DNhttp://images.google.ro/imgres?imgurl=http://www1.istockphoto.com/file_thumbview_approve/405188/2/istockphoto_405188_peace_sign_two_fingers_isolated.jpg&imgrefurl=http://www.istockphoto.com/imageindex/405/1/405188/Peace_sign_two_fingers_isolated.html&h=380&w=253&sz=22&hl=ro&start=42&um=1&tbnid=Jefb8xaiUgu5vM:&tbnh=123&tbnw=82&prev=/images%3Fq%3Dtwo%2Bfingers%26start%3D40%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Dro%26sa%3DN

Laringoscopia

Mallampati

Clasa I = intubatie usoara 99%

Clasa IV = intubatie dificila 99%

laringoscopia

http://images.google.ro/imgres?imgurl=http://medicine.ucsd.edu/clinicalmed/head-neck-normal-oral.jpg&imgrefurl=http://medicine.ucsd.edu/clinicalmed/neuro2.htm&h=960&w=1280&sz=345&hl=ro&start=184&tbnid=Hpg52tW6BEL1uM:&tbnh=113&tbnw=150&prev=/images%3Fq%3Dneck%2Bmobility%26start%3D180%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Dro%26sa%3DN

Mallampati, Cormach si Lehand A,

oral si B, vederea la laringoscopie 1. Se vizualizeaza

pilierii , palatul moale si uvula

2. Se vad pilierii si palatul moale, iar uvula este ascunsa sub baza limbii

3. Se vede doar palatul moale

4. Nu se vede nici

palatul moale Clasa I: se vad corzile vocale

Clasa II: corzile vocale se vizualizeaza partial

Clasa III: se vede doar epiglota

Clasa IV: nu se vede nici epiglota

Examenul preanestezic (IV)

F. Stabilirea riscului anestezico-chirurgical SCOR ASA(American Society of Anesthesiology)

ASA Definitie Mortalitate asociata

I Pacient sanatos fara probleme

medicale 0,1%

II Boala sistemica usoara 0,2%

III Boala sistemica severa dar fara

incapacitarea pacientului

1,8%

IV Boala sistemica severa care

incapaciteaza pacientul

7,8%

V Muribund care se presupune ca

nu va supravietui 24 indiferent

de interventia chirurgicala

9,1%

VI Donatorul de organe

*E -

Intubatia oro-traheala (IOT)

Materiale ptr intubatie

Balon ruben + masca faciala

Laringoscop cu lame diverse

Sonde diverse

Mandren/ bujii etc

Masti laringiene 3 & 4

Set de punctie cricotiroidiana canula14 Gauge si sistem de insuflatie jet

Sistem functional de aspiratie

Un asistent antrenat

Preoxigenare

Abord venos

Toate materialele / aparatele pregatite si verificate

http://images.google.ro/imgres?imgurl=http://www.microglass.it/3_USI_GENERALI/3_USI_GENERALI_PICS/siringes_bd.jpg&imgrefurl=http://www.microglass.it/3_USI_GENERALI/3_USI_GENERALI_PAGES/3main_siringhe.htm&h=296&w=235&sz=14&hl=ro&start=1&tbnid=DeYG-3ZNYKke-M:&tbnh=116&tbnw=92&prev=/images%3Fq%3D%2Bsiringes%26gbv%3D2%26svnum%3D10%26hl%3Dro%26sa%3DG

Laringoscopul

http://images.google.ro/imgres?imgurl=http://www.footecmedical.com/Pictures/Laryngoscope7623.JPG&imgrefurl=http://www.footecmedical.com/Laryngoscopes.htm&usg=__KzjuCnCUe4_0fNYwqt-7w6ATHC8=&h=289&w=300&sz=15&hl=ro&start=16&sig2=q_ywTF2xviJ8k9dYKxmy6A&tbnid=s28XAfLixTeSuM:&tbnh=112&tbnw=116&ei=EeskSZaDJIvo7QXL64Ba&prev=/images%3Fq%3Dlaryngoscope%26gbv%3D2%26hl%3Dro%26sa%3DG

Masca oxigen