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  1.  optimální poloha je tzv. sniffing position („čichací poloha“): flexe krku, extenze hlavy (podložená)
  2.  počkat, až plně nastoupí relaxace (desítky sekund!), mezitím preoxygenovat, neprodýchávat vysokým tlakem (možnost insuflace žaludku, regurgitace, aspirace), raději inhalovat kyslík 10–15 l/min.
  3.  laryngoskop zavést levou rukou, v ose 45°, špičkou zahnuté lžíce (McIntosh) do valekuly, tzn. nad epiglottis
  4. táhnout v ose rukojeti, netlačit na zuby, pozor, aby se mezi lžíci a zuby nedostal jazyk nebo ret
  5. rourku zavést po bezpečné vizualizaci vchodu do hrtanu tak, aby obturační manžeta byla za hlasovými vazy
  6. pokud jsou hlasové vazy u sebe, nezavádět (žádné násilí) – prodýchat, počkat do nastoupení relaxace, prohloubit
  7. rourka se zavádí u dospělého na 20–24 cm, u dětí zhruba na vzdálenost (24 + věk) : 2, respektive trojnásobek průměru rourky v cm
  8. při špatné viditelnosti zatlačit pravou rukou na krk: „dozadu, doprava a nahoru“ (ev. drží pomocník)
  9. obturační manžeta je tzv. nízkotlaká vysokoobjemová – plní se 10–20 ml vzduchu (tlak 15–30 cmH2O, balónek musí být na pohmat měkký)
  10. po nafouknutí prodýchat vakem, poslouchat v axillách a nad žaludkem. Pokud v pořádku, fixovat rourku do koutku náplastí, připojit  ventilátor.

 

 

 

„dostatečná preoxigenace;
podání anestetik (hypnotikum, opiát- Thiopental, Diprivan);
pokud lze pacienta dostatečně prodýchat maskou podáme myorelaxans (Succinylcholinjodid, …;
po nástupu relaxace (Sux- do minuty) otevřeme ústa;
zasuneme laryngoskop mezi kořen jazyka a epiglotis a tahem směrem nahoru a dopředu (Pozor:NE PÁČENÍ!) získáme pohled na hlasivky;
pravou rukou za neustálé kontroly hlasových vazů zasuneme tubus do hlasové štěrbiny;
nafouknutí manžety tubusu;
připojíme tubus k anesteziologickému přístroji, Abmbuvak a ověříme správnou polohu tubusu.“

Známky úspěšné intubace:
Jisté známky
přímá laryngoskopie a zraková kontrola průchodu tubusu hlasovou štěrbinou;
kapnometrie (CO2);
bronchoskopie.

Nejisté známky
exkurze hrudníku;
auskultace;
konstantní hodnota oxymetrie.

• ověření polohy ET rourky:
– správná poloha: rourka se rosí ve výdechu, symetrické exkurze hrudníku a poslech v axillách (pokud dýchá pouze 1 plíce, vypustit manžetu, rourku mírně povytáhnout, nafouknout manžetu a opět poslechnout)
–poloha v jícnu: rourka se nerosí, hrudník se nezvedá, nafukuje žaludek, ETCO2 neměřitelné

Komplikace:
mechanické poškození – sliznice, zubů, průdušnice, jícnu, hlasových vazů;
stimulace reflexů – sympatikotonické, vagové;
jednostranná intubace (častěji pravostranná);
obstrukce tubusu;
krvácení;
dekubity;
paréza hlasových vazů.

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