Information
Editors
Airway Management and Assisted Ventilation in an Emergency
Essentials
- Respiratory insufficiency is managed by ensuring a patent airway and assisting ventilation. The most common causes of loss of airway patency and/or respiratory insufficiency are cardiac arrest, impaired consciousness or critical respiratory distress.
- The simplest way to ensure airway patency and to assist ventilation is to open the airway manually and to start assisting ventilation using a bag-mask attached to oxygen.
- The airway must be kept patent and maintained using an airway device, such as an oropharyngeal (oral) or supraglottic airway, an endotracheal tube or by an emergency tracheotomy.
- For emergency tracheotomy i.e. cricothyrotomy, see videos Cricothyrotomy Using an Intubation Tube (Emergency Tracheotomy) and Cricothyrotomy Using a Mini-Trach Cannula (Emergency Tracheotomy).
Primary measures
- In patients with cardiac arrest or impaired consciousness, assisted ventilation should primarily be started using a bag-mask attached to oxygen http://www.dynamed.com/condition/cardiac-arrest-in-adults#ADVANCED_CARDIOVASCULAR_LIFE_SUPPORT__ACLS_.
- If in hospital, always ask for further assistance according to local guidelines.
- In a health care unit, act according to local guidelines and/or call the emergency number (112) to get support from emergency services for treatment and to have them take the patient for further treatment, as necessary.
- To facilitate bag-mask ventilation, an oral airway should be inserted, as necessary (Image ).
- Choose a size 3-4 oral airway for an adult, a smaller one for a child. The correct length is the distance from the corner of the patient's mouth to the earlobe.
Choice of airway device
- Laryngeal mask airway, LMA
- The correct size depends on the manufacturer and the model.
- Laryngeal tube, LT
- For choice of size, see Table T1.
- i-gel®
The most common problems
- Placement of the laryngeal mask airway (LMA) does not result in a good seal.
- Wrongly chosen size of device
- Device introduced obliquely into the pharynx
- Fix the problem by reinserting the device.
- The laryngeal tube (LT) does not produce a good seal.
- Make sure that the cuff is intact and the air volume correct.
- Check the correct depth (deflate slightly, as necessary, insert at correct depth, fix carefully).
Choosing the size of laryngeal tube (LT-D)
| Patient's weight/height | LT-D colour* | LT-D no. |
---|
Child | 12-25 kg | green | 2 |
| 125-150 cm | orange | 2.5 |
Adult | <155 cm | yellow | 3 |
| 155-180 cm | red | 4 |
| >180 cm | purple | 5 |