# 氣切3天病人因劇咳整支氣切管脫出,出現呼吸窘迫。適當行動?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374980&lang=zh-tw  
> language: zh-TW  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## 題目

氣切3天病人因劇咳整支氣切管脫出,出現呼吸窘迫。適當行動?複選。

1

"將個案平躺，頸部過度屈曲，使造口可見以利重新插管。"

2

"等待快速反應小組到達後，再嘗試通氣或重新插管。"

3

以無菌紗布蓋住造口,經口鼻面罩通氣

4

持續給氧並準備由熟練的臨床醫師進行經口插管的同時，呼叫快速反應小組或呼吸道小組

5

為熟練的呼吸道臨床醫師準備相同尺寸及較小的備用管路與管芯，不嘗試盲目重新插入

## 解析

氣切造口建立僅3天，通道尚未成熟；意外脫管可能形成假通道，因此屬於呼吸道急症。選項1不正確，因為頸部過度屈曲會遮擋造口視野並影響呼吸道對位。選項2不正確，因為呼叫支援的同時必須立即開始給氧。選項3在上呼吸道通暢時正確：封住造口，使用袋瓣面罩經口鼻通氣。選項4正確，因為持續給氧時應立即啟動呼吸道專業團隊；若面罩通氣不足，應由熟練的臨床醫師準備經口插管。選項5正確，因為應為呼吸道團隊備妥同尺寸、較小一號的備用管及閉孔器，但護理人員不應在看不到路徑時，將管路強行插入尚未成熟的通道。

## 深入解析

床邊緊急包:obturator、同尺寸與小一號備管、抽吸、無菌紗布、剪刀、cuff注射器。熟記順序。

## 臨床情境

床邊備品就緒:obturator、同尺寸與小一號備管、抽吸。SpO2 87%下降中。

## 重要概念

- **脫管** — 氣切管移除或脫出 — 新造口時為急症。
- **Obturator** — 圓滑導芯 — 套入氣切管助再置入。
- **造口瘻管** — 從皮膚至氣管之通道 — 術後7-10天成熟。

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