ICU气管切开小讲课PPT课件

广东省人民医院*广东省人民医院*广东省人民医院事故发生时从飞机上跳下来，结果坐在了火堆上*广东省人民医院患者情况 重度吸入性损伤，肺部挫伤和多发性骨折，伤势严重，出现烦躁、胸闷、呼吸困难并逐渐加重。 呼吸道黏膜损伤严重，咽喉充血水肿，呼吸道大量粘稠分泌物不易咳出。 PaO2为7.0kPa，PaCO2为5.0kPa，血氧饱和度为80左右，给予吸氧时升高不明显。 双肺有广泛的湿啰音、哮鸣音。*广东省人民医院患者情况 重度吸入性损伤，肺部挫伤和多发性骨折，伤势严重，出现烦躁、胸闷、呼吸困难并逐渐加重。 呼吸道黏膜损伤严重，咽喉充血水肿，呼吸道大量粘稠分泌物不易咳出。 PaO2为7.0kPa，PaCO2为5.0kPa，血氧饱和度为80左右，给予吸氧时升高不明显。 双肺有广泛的湿啰音、哮鸣音。*广东省人民医院*CompanyLOGO气管切开的配合及术后护理学生：刘婉婷、曾慧红李额伶、邓健广东省人民医院1.了解气管切开的位置3.熟悉气管切开术的配合4.掌握气管切开术后护理2.了解气管切开术前准备学习目标*广东省人民医院位置：第3、4环状软骨气管切开 是一种切开颈段气管前壁并插入气管套管，使病人直接经气管套管呼吸的急救手术*广东省人民医院气切时护士的工作配合用物准备：一次性经皮气管切开术包一套，皮肤消毒用物,无菌手套，无菌纱块，无菌治疗巾，吸痰装置,一次性吸痰管数根，喉镜一套、鹅颈灯一台，简易呼吸器等**SpeakerNotesUsethisspaceforoverallnotesandgeneralcomments.Simplyselectthistextandreplaceitwithyourowncomments.SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.广东省人民医院药物准备肾上腺素等急救药品2％利多卡因用于局部麻醉吗啡、力月西用于镇痛镇静**SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccasion.Simplyselectthistextandreplaceitwithyourownreminders.广东省人民医院患者准备术前给予患者严密监测血压、心率、血氧饱和度等充分吸净病人口腔、气管内的分泌物，保持呼吸道通畅给予有效的氧气吸入或呼吸机辅助通气意识清醒者做好心理疏导，鼓励病人配合好手术**SpeakerNotesUsethisspaceforoverallnotesandgeneralcomments.Simplyselectthistextandreplaceitwithyourowncomments.SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.广东省人民医院术中配合协助医生摆好体位，将平卧位患者肩下垫入枕头，使其头部后仰，充分显露颈前区遵医嘱予适当给予镇静药物或肌松药物穿刺过程中注意观察生命体征、血氧饱和度及皮肤黏膜的改变，及时报告医生**Manypeopledonotunderstandthatethicsaresituation-specificandtime-based--andbusinessethicsarenoexception.TeachingTip:Butthisdoesnotmeanthatethicsarecapriciousorunimportant.Infact,allsocietieshaveacodeofethicsandmorebusinessesthaneverrecognizethatastrongcodeofethicsisgoodbusiness:itcanprotectthecompanyfrominternalwrong-doingandpossiblelegalliability,and,formarketers,serveasastrongfoundationuponwhichtobuildlong-termcustomerrelationships.Ethicaldevelopmentcanbethoughtofashavingthreelevels:PreconventionalMorality.Thischildlikeleveliscalculatingandself-centered.Asaselfishmorality,itistypicallybaseduponwhatislikelytobeimmediatelyrewardedorpunished.ConventionalMorality.Atthislevelthefocusmovesawayfromtheselfandtowardtheexpectations(conventions)ofthesocietyinwhichtheindividuallives.Loyaltyandobedienceto“therules”areimportantandthisbehaviorcanbegeneralizedfromsocietyasawholetoanattachmenttoone’scompanyororganization.Marketersatthislevelareconcernedwithwhetherornotanactivityislegalandhowitisviewedbyothers.PostconventionalMorality.Atthislevel,theindividualtakesalong-runviewofherorhisactions,weighingtheminrelationtoterminalvaluesandmattersofprinciple.Thisisthemoralityofthematureadult.广东省人民医院术中配合当扩张钳扩大气管切口后,痰液、血液自切口涌出,应及时吸尽痰液和血液待医生放入气切导管后应迅速充足气囊，并及时吸出气道中痰血混合液及时用胶布等固定气切导管，气切管固定应松紧适宜(带下可容一指为宜)确认气管套管在气管内后,应尽快给予气管套管内吸氧或机械通气**SummaryOverviewXXXXMajorTitleHeading.ThissliderelatestoXX-XX.广东省人民医院*广东省人民医院术后护理给予持续气道湿化，以输液方式将湿化液缓慢滴入气管内，滴速控制在每分钟4-6滴，每昼夜不少于200ml，或根据具体情况给予雾化保持套管通畅：随时吸痰，每日消毒内管3-4次,用75%酒精浸泡30min。保持室内适宜的温湿度,一般要求室温20～22℃,湿度60%～70%内管**SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccasion.Simplyselectthistextandreplaceitwithyourownreminders.广东省人民医院术后护理密切观察病情变化，保持人工气道通畅，密切观察患者生命体征的变化，尤其是患者血氧情况以及痰液性状严密观察切口有无出血现象，保持局部清洁、干燥。每天更换敷料1~2次观察有无软组织、气管黏膜、切口的出血，有无切口感染，皮下气肿、纵隔气肿等并发症保持适当的气囊内压，气囊硬度以如触鼻尖为宜，每天监测气囊的压力有无改变**SummaryOverviewXXXXMajorTitleHeading.XXXXHeading.XXXXHeading.XXXXHeading.XXXXReplacewithpresentationnoteshere.广东省人民医院气切的位置？局麻药是？固定标准？室温湿度？重点观察？小结**SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccassion.Simplyselectthistextandreplaceitwithyourownreminders.广东省人民医院**SpeakerNotesUsethisspaceforoverallnotesandgeneralcomments.Simplyselectthistextandreplaceitwithyourowncomments.SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.*SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccasion.Simplyselectthistextandreplaceitwithyourownreminders.*SpeakerNotesUsethisspaceforoverallnotesandgeneralcomments.Simplyselectthistextandreplaceitwithyourowncomments.SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.*Manypeopledonotunderstandthatethicsaresituation-specificandtime-based--andbusinessethicsarenoexception.TeachingTip:Butthisdoesnotmeanthatethicsarecapriciousorunimportant.Infact,allsocietieshaveacodeofethicsandmorebusinessesthaneverrecognizethatastrongcodeofethicsisgoodbusiness:itcanprotectthecompanyfrominternalwrong-doingandpossiblelegalliability,and,formarketers,serveasastrongfoundationuponwhichtobuildlong-termcustomerrelationships.Ethicaldevelopmentcanbethoughtofashavingthreelevels:PreconventionalMorality.Thischildlikeleveliscalculatingandself-centered.Asaselfishmorality,itistypicallybaseduponwhatislikelytobeimmediatelyrewardedorpunished.ConventionalMorality.Atthislevelthefocusmovesawayfromtheselfandtowardtheexpectations(conventions)ofthesocietyinwhichtheindividuallives.Loyaltyandobedienceto“therules”areimportantandthisbehaviorcanbegeneralizedfromsocietyasawholetoanattachmenttoone’scompanyororganization.Marketersatthislevelareconcernedwithwhetherornotanactivityislegalandhowitisviewedbyothers.PostconventionalMorality.Atthislevel,theindividualtakesalong-runviewofherorhisactions,weighingtheminrelationtoterminalvaluesandmattersofprinciple.Thisisthemoralityofthematureadult.*SummaryOverviewXXXXMajorTitleHeading.ThissliderelatestoXX-XX.*SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccasion.Simplyselectthistextandreplaceitwithyourownreminders.*SummaryOverviewXXXXMajorTitleHeading.XXXXHeading.XXXXHeading.XXXXHeading.XXXXReplacewithpresentationnoteshere.*SummaryHeading.Text.Heading.Text.Heading.Text.Heading.Text.Usethisspaceforoverallremindersorspecialtipslinkedtotheslideoroccassion.Simplyselectthistextandreplaceitwithyourownreminders.