간호 술기- intubation, extubation, CPR, cardioversion, defibrillation

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1. Intubation

Intubation은 환자의 입이나 코를 통하여 기관 삽관 튜브를 삽입하여, 성대 사이의 후두를 통해서 기관에 삽입하는 방법입니다. 주요 목적은 기도의 개방성 유지, 흡인 방지, 분비물 제거 용이, 양압적 인공호흡 가능, 산소화와 환기 용이, 응급 투약 경로 확보 등입니다. 적응증으로는 상기도 폐쇄, 무호흡, 분비물 제거 비효율, 흡인 위험, 호흡 부전, 기계적 환기 요구, 전신마취 등이 있습니다. Intubation 시 준비물품으로는 laryngoscope, endotracheal tube, stylet, ambu bag, airway, syringe, suction 등이 필요하며, 시행 방법은 환자 상태 확인, 산소 공급, 삽관 및 cuff 확인, 고정 등의 순서로 진행됩니다.
2. Extubation

Extubation은 환자 스스로 숨을 쉴 수 있거나 가래를 배출할 수 있을 때 기관튜브를 제거하는 것을 말합니다. 주요 적응증은 인공기도가 필요했던 기저 상황 호전, 혈역학적 안정, 분비물 제거 능력 회복, 흡인 가능성 감소, 인공 환기 지지 불필요 등입니다. Extubation 시 준비물품으로는 마스크, suction 물품, syringe, O2 flowmeter 등이 필요하며, 시행 방법은 환자 설명, suction 시행, 튜브 제거, 산소 공급, ABGA/X-ray 확인 등의 순서로 진행됩니다.
3. CPR

CPR(심폐소생술)은 심장의 박동과 폐의 호흡이 정지된 상태에서 인공호흡과 흉부압박을 통해 주요 장기에 산소를 공급하는 치료 술기입니다. 기본 소생술(BLS)과 전문 심장소생술(ACLS)로 구분되며, 심폐정지 확인, CPR팀 연락, 기본 CPR 시행, 전문 치료 등의 과정으로 이루어집니다. CPR 시 주요 내용은 심전도 리듬 분석, 가슴압박, 제세동, 전문기도유지술, 약물 투여, 원인 치료 등입니다.
4. Defibrillation

Defibrillation은 심근을 동시에 완벽하게 탈분극 시켜 ventricular fibrillation을 유도한 모든 회귀회로를 차단하고 동방 결절의 정상적인 기능을 회복시키는 치료법입니다. 적응증은 pulseless v-tac, ventricular fibrillation 등이며, 에너지 용량은 소아 2-4J/kg, 성인 monophasic 360J, biphasic 200J 등입니다. 준비물품으로는 defibrillator, paddle, 젤리 등이 필요하며, 절차는 defibrillator 작동, 에너지 선택 및 충전, paddle 위치 선정, 제세동 시행, 반응 확인 등의 순서로 진행됩니다.
5. Cardioversion

Cardioversion은 불안정한 빈맥성 부정맥을 치료하기 위해 심장주기의 R wave에 시간을 맞추어 심실을 탈분극 시켜 정상적인 전도체계를 회복시키는 치료법입니다. 적응증은 혈역학적으로 불안정한 atrial fibrillation, atrial flutter, 심근 허혈로 인한 부정맥, recentry arrhythmia 등입니다. 에너지 용량은 소아 1-2J/kg, 성인 50-200-300J 등이며, 절차는 환자 위치 선정, 전도물질 제거, 동기화 및 충전, 제세동 시행, 반응 확인 등의 순서로 진행됩니다.

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1. Intubation

Intubation is a critical medical procedure that involves inserting a tube into a patient's airway to facilitate breathing. It is a complex and delicate process that requires extensive training and expertise. Proper intubation is essential in emergency situations, such as when a patient is unable to breathe on their own due to injury, illness, or anesthesia. The procedure must be performed with great care and precision to avoid complications, such as damage to the airway or esophagus. Intubation is a vital skill for healthcare professionals, particularly in fields like emergency medicine, anesthesiology, and critical care. It is a procedure that should only be undertaken by those with the appropriate training and experience to ensure the best possible outcome for the patient.
2. Extubation

Extubation is the process of removing a breathing tube, or endotracheal tube, from a patient's airway. This procedure is typically performed when a patient no longer requires mechanical ventilation and is able to breathe independently. Proper extubation is crucial to ensure a smooth transition back to natural breathing and to prevent complications, such as airway obstruction or respiratory distress. Healthcare professionals must carefully assess the patient's readiness for extubation, considering factors like respiratory function, airway reflexes, and overall stability. The timing and technique of extubation can have a significant impact on the patient's recovery and long-term outcomes. Extubation requires a high level of skill and vigilance to ensure the safe and successful removal of the breathing tube.
3. CPR

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that is essential in emergency situations where a person's heart and breathing have stopped. CPR involves a combination of chest compressions and rescue breaths to maintain blood flow and oxygenation until more advanced medical care can be provided. Effective CPR can significantly increase a person's chances of survival in the event of cardiac arrest or other life-threatening emergencies. It is a critical skill that should be widely known and practiced, as it can be performed by bystanders and first responders before emergency medical services arrive. Proper training and regular practice are crucial to ensure that individuals are prepared to perform CPR effectively and confidently when needed. CPR is a vital component of emergency medical care and can make the difference between life and death in many situations.
4. Defibrillation

Defibrillation is a crucial medical intervention used to treat certain types of life-threatening cardiac arrhythmias, such as ventricular fibrillation and pulseless ventricular tachycardia. It involves the delivery of an electric shock to the heart, which can restore normal heart rhythm and prevent sudden cardiac death. Defibrillation is a time-sensitive procedure, as the chances of survival decrease rapidly with each minute that passes without treatment. Automated external defibrillators (AEDs) have made defibrillation more accessible to the general public, allowing bystanders to provide this lifesaving intervention in emergency situations. Proper training and familiarity with the use of AEDs are essential to ensure that defibrillation is performed safely and effectively. Defibrillation, combined with high-quality CPR, is a critical component of the chain of survival for individuals experiencing sudden cardiac arrest.
5. Cardioversion

Cardioversion is a medical procedure used to restore a normal heart rhythm in individuals experiencing certain types of abnormal heart rhythms, or arrhythmias. It involves the delivery of a controlled electric shock to the heart, which can help to terminate the abnormal rhythm and restore a normal sinus rhythm. Cardioversion is typically performed in a hospital setting, often under the supervision of a cardiologist or other trained medical professionals. The procedure is generally considered safe and effective, but it does carry some risks, such as the potential for complications related to the electric shock or the underlying medical condition. Proper patient selection, preparation, and monitoring are crucial to ensure the safety and success of the procedure. Cardioversion can be a lifesaving intervention for individuals experiencing dangerous or persistent arrhythmias, and it is an important tool in the management of various cardiac conditions.