Pr�klinische Sicherung der Atemwege

Thierbach, Andreas; Piepho, T.; Wolcke, Benno; Kuster, Stefan P.; Dick, W.

doi:10.1007/s00101-004-0679-z

Cited by 46 publications

(13 citation statements)

References 31 publications

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“…Versuch; bei lediglich 2,7% waren mehr als 2 Versuche erforderlich. Bei 1,5% der Patienten (n = 9) wurden nach dem 3. erfolglosen Intubationsversuch alternative Methoden zur Atemwegssicherung verwendet (Kombitubus, n = 7; Larynxmaske, n = 1; Notfallkoniotomie, n = 1; [93] …”

Section: Einsatz Alternativer Methoden Zur Atemwegssicherungunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.

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Section: Einsatz Alternativer Methoden Zur Atemwegssicherungunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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“…Ungeübte Anwender sollten auf alternative Atemwegshilfen zurückgreifen [8]. Im präklinischen Notfall treten jedoch auch Situationen auf, in denen selbst ein geübter Intubateur mit einem schwierigen Atemweg konfrontiert wird, die Intubation misslingt und eine alternative Atemwegshilfe zur Anwendung kommen muss [17]. Angegeben sind n und (%).Mehrfachnennungen möglich.…”

Section: Kurskonzept Und Ergebnisseunclassified

Implementierung des Larynxtubus im präklinischen Atemwegsmanagement

Schalk

Auhuber

Haller³

et al. 2012

Anaesthesist

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A standardized training concept enabled almost 1,100 rescuers to be trained in the use of an alternative airway device and to successfully implement the LTS-D into the prehospital airway management algorithm. Because the LTS-D recently became an accepted alternative to endotracheal intubation in difficult airway scenarios, the number of intubation attempts before considering an alternative airway device is steadily decreasing.

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“…49%; [67]). Hinzu kommt, dass die präklinische Intubation im Vergleich zur Routineanästhe-sie überproportional häufig mit Komplikationen assoziiert ist [66]. So berichten Timmermann et al [67] von einer Komplikationsrate bzw.…”

Section: Atemwegssicherung In Der Notfallmedizinunclassified

Indirekte Laryngoskopie

Werner²,

Piepho³

2010

Anaesthesist

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Endotracheal intubation remains the gold standard for securing the airway in emergency medicine. However, difficult endotracheal intubation and complications are common during emergency intubation. In contrast to conventional direct laryngoscopy, the new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. These devices allow a better glottic view and successful endotracheal placement of the tube, especially if direct laryngoscopy is difficult. Recent studies showed that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for securing the airway in daily anesthesia routine as well as for managing the difficult airway in the operating room. This article gives an overview of available devices for indirect endotracheal intubation as well as the current literature.

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Pr�klinische Sicherung der Atemwege

Abstract: Prehospital airway management by emergency physicians experienced in anaesthesia is associated with low complication and high success rates.

Cited by 46 publications

References 31 publications

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

Implementierung des Larynxtubus im präklinischen Atemwegsmanagement

Indirekte Laryngoskopie

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