Sharma Rajeev, Kaushal Vidit, Tyagi Mohit, Mittal Ashish
Department of Anesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
J Emerg Med. 2017 Nov;53(5):746-748. doi: 10.1016/j.jemermed.2017.06.036. Epub 2017 Sep 2.
Fiberoptic bronchoscope-guided tracheal intubation is the gold standard for managing patients with supraglottic growths. In infants with a large and overhanging epiglottis, the success of fiberoptic-guided intubation relies heavily on the available space between the inferior surface of the epiglottis and the posterior pharyngeal wall or, more specifically, the superior surface of the supraglottic growth.
We describe the inability to negotiate the tip of the fiberscope between the epiglottis and the supraglottic growth and the successful use of direct laryngoscopy to improve the available space along with the usefulness of "bubbling of air" to locate the glottic opening in an infant. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We emphasize the role of the emergency physician in managing such patients. Most of the time, the setting is not ideal in such emergency situations and the most qualified clinician to treat them is the emergency physician. The knowledge and skills of the emergency physician, along with awareness of the possible techniques for airway management, can be lifesaving.
纤维支气管镜引导下气管插管是治疗声门上肿物患者的金标准。对于会厌大且下垂的婴儿，纤维支气管镜引导下插管的成功在很大程度上依赖于会厌下表面与咽后壁之间的可用空间，或者更具体地说，依赖于声门上肿物的上表面。
我们描述了纤维支气管镜尖端无法在会厌和声门上肿物之间通过，以及成功使用直接喉镜检查来增加可用空间，同时还介绍了“空气泡法”在确定婴儿声门开口位置方面的作用。
急诊医生为何应了解这一点？：我们强调急诊医生在处理此类患者中的作用。大多数情况下，此类紧急情况的环境并不理想，而最有资格治疗这些患者的临床医生就是急诊医生。急诊医生的知识和技能，以及对气道管理可能技术的认识，可能会挽救生命。
