Title: Intubation Pearls(Ps)
题目：气管插管的要点（Ps）
Author 作者: Benjamin Lawner

When considering an intubation or managing an emergent respiratory concern, keep the "P"s of intubation in mind:
在考虑要插管或抢救急性呼吸困难时，要记住几个与插管有关的“P”：

1. P osition: No intubating on the floor! Maintain an appropriate distance. Align the airway axes. Sniffing position is utilized for non traumatic adult airways; this involves flexion of the lower c-spine and a bit of extension at the upper cervical levels. Take off cervical collars. Use pillows / blankets to align the external auditory canal (EAC) with the sternal notch to help w/visualization. Cricoid pressure is NOT designed to facilitate passage of the ETT- it MAY help prevent excessive gastric insufflation.
位置（Position）：千万不要在地板上插管！保持适当的距离。对齐呼吸道轴线。嗅闻位置是用于非创伤成年病人，使下部颈椎前屈而上部颈椎后仰。解开颈托，用枕头和毯子将外耳道和胸骨切记对齐以帮助直视（声门）。环状软骨加压并不是用来帮助放置器官导管，可能会防止大量胃内容物窒息。

2. P reparation: Two tubes. Two blades. Two intubators. Plan B(ougie) or Plan C(cric). Though your emergency airway plans may differ, think of ALL airways as potentially difficult ones. Respect the epiglottis.
准备（Preparation）：两个导管，两个喉镜，两个插管人。要准备好计划B（Bougie，弹性引导管芯）和计划C（Cric，气管切开）。虽然急诊呼吸道的方案不同，但一定要把所有的呼吸道都作为困难呼吸道处理。对会厌要尊敬。

3. Preoxygenation: 100% via NRBM when possible to ensure oxygenation and nitrogen washout. In patinets with at least some reserve, this will help to avoid pulse ox pitfalls. True RSI does NOT involve positive pressure ventilation.
前期给氧（Preoxygenation）：在可能情况下，为保证氧合和排出氮气，要通过非呼吸器面罩输100％的氧。真正的快速程序诱导插管并不需要正压通气。

4. Premedication: Know your sedatives in advance. Etomidate ?Ketamine ?Diprivan ? Whatever your agent of choice, know indications and drug dosages. Emergent RSI is a less than ideal time to access Epocrates.
操作前给药（Premedication）：要提前掌握你的镇静要，依托咪酯？，氯胺酮？，或异丙酚？无论你的选择是什么，要了解它们的适应症和剂量。急诊情况下，你不可能有时间再查Epocrates（参考文献）。

5. Paralysis: This is pretty much the point of no return. Administration of paralytics commits you to securing a patient's airway. Both rocuronium and succynylcholine can be dosed at 1 mg/kg IV.
肌肉松弛（Paralysis）：这时你不可能再回头了。给了肌松剂你就必须要保护并入的呼吸道。罗库溴铵和琥珀酰胆碱都可以给1mg／kg静脉。

6. P ass the tube
放入导管（Pass the tube）

7. P osition confirmation: Direct visualization of the tube through the glottic opening coupled with end tidal Co2 is ideal.
位置证实（Position confirmation）：最好要在直视声门下和呼吸末期CO2监测下进行插管。