2 0 0 0 OA 成人の急性喉頭蓋炎と気道確保について
- 著者
- 川嶋 隆久
- 出版者
- 日本喉頭科学会
- 雑誌
- 喉頭 (ISSN:09156127)
- 巻号頁・発行日
- vol.17, no.2, pp.56-60, 2005-12-01 (Released:2012-09-24)
- 参考文献数
- 13
Acute epiglottitis, as well as airway management of this malady in adults, can rapidly deteriorate into an airway obstruction. This potential emergency demands prompt evaluation of the epiglottis with an emphasis on vigilant and proficient attention to airway management. During the examination, the patient should be in a sitting position while under intense observation in preparation for tracheal intubation at any time. For patients affected by respiratory distress, ventilation with 100% O2 and urgent intubation are needed. Choose 1 or 2 sizes smaller than the usual tube size for intubation. Oral intubation along with administration of a sedative and muscle relaxant is comparatively safe and easy. However, in cases where : 1) difficulty in airway establishment is anticipated, 2) SpO2 does not elevate in spite of enough O2 supply, or 3) the patient is already in shock, a sedative or muscle relaxant would precipitate respiratory arrest. In such cases, consider whether oral intubation without a sedative or muscle relaxant or nasal intubation with an endoscope can be performed. Nasal intubation with an endoscope in a sitting position might be effective. For the patient in agony or with difficulty in opening their mouth, intubate after administrating a little amount of sedative while monitoring blood pressure and SpO2. If it is difficult to establish their airway rapidly, administrate vecuronium and choose oral tracheal intubation while being prepared for implementing an emergent tracheotomy, or a cricothyroidotomy; either needle or surgical. If unable to intubate successfully, ventilate with the bag-valve-mask technique with 100% O2 as far as possible, then provide an emergent tracheotomy, needle or surgical cricothyroidotomy immediately.