unger airway dem2014_final

Verschiedene Airway- Algorithmen

http://www.vortexapproach.com/Vortex_Approach/Vortex.html

Mendelsons- Syndrom (1946) Mortality former times up to 60%, now ~ 3%

Mortality servere ARDS in prone position 23,6%

Aspiration (RSI in ED) 0,8-5,9%DeSat (RSI in ED) 9,2-37,8%

Priority on alveolar oxygenation

NO DESAT

Don't fail to Plan for Failure

Cook TM et al. NAP4. BJA 106 (5): 632–42 (2011) .

Vortex

etCO2: Capnography

metabolism - cardiac output - perfusion - ventilation

.

http://www.vortexapproach.com/Vortex_Approach/Vortex.html

.

Naso-pharyngeal

Extraglottic airway- devices

Oro-pharyngea

l

BLS

Gerstein NS et al. Efficacy of facemask ventilation techniques in novice providers. J Clin. Anesth 2013 May;25(3):193-7

mask

thermo- elastomeric material (self-adapting)

vent reduces risk of aspiration

iGEL-

Laryngeal tube2 cuffs

with one blow

Cricoid- pressure no more imperativley recommendedComplications follow First-attempt Failure

Some Training for ETI requiredChecklists support procedure

Trained Teams Succeed

TransglotticEndotracheal Intubation

..

...no clear recommendations...

Airway- competent

societies…

.Emergency surgical

airway

.

Cric-Kit (1959)

Peter Safar

Plan for Failure5 Airways Progress in Process

NODESAT

references*American Society of Anesthesiologists: Practice guidelines for management of the difficult airway: Anesthesiology 2003;

98:1269–1277. update: Anesthesiology 2013; 118:251–70

J. J. Henderson et al. Difficult Airway Society guidelines for management of the unanticipated difficult intubation http://www.das.uk.com

A. Timmermann et al. Handlungsempfehlung für das präklinische Atemwegsmanagement* Anästh Intensivmed 2012;53:294-308

T. M. Cook 1 et al. On behalf of the Fourth National Audit Project. British Journal of Anaesthesia 106 (5): 632–42 (2011)

Christopher T. et al. The Success of Emergency Endotracheal Intubation in Trauma Patients: A 10-Year Experience at a Major Adult Trauma Referral Center. Anesth Analg 2009;109:866–72

Chesters A. et al. Prehospital anaesthesia performed in a rural and suburban air ambulance service staffed by a physician and paramedic: a 16-month review of practice. Emerg Med J. 2014 Jan;31(1):65-8.

Ellis DY et al. Cricoid pressure in emergency department rapid sequence tracheal intubations. Ann Emerg Med 2007;50:653-65

Bernhard M et al. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta AnaeScand 2012;56:164-171

Alexander F. Arriaga et al. Simulation-Based Trial of Surgical-Crisis Checklists NEJM 2013; 368:246-253

http://www.intersurgical.com/ http://daveairways.wordpress.com/http://www.vortexapproach.com/Vortex_Approach/Vortex.html

Müller JU et al. The use of the laryngeal tube disposable by paramedics during out-of-hospital cardiac arrest: a prospectively observational study Emerg Med J. 2013 Dec;30(12):1012-6.

Schalk R. et al. Disposable laryngeal tube suction: standard insertion technique versus two modified insertion techniques for patients with a simulated difficult airway. Resuscitation. 2011 Feb;82(2):199-202

V. Dengler et al. Präklinische Anwendung des Larynxtubus Der Anaesthesist February 2011, Volume 60, Issue 2, pp 135-138

John C. Sakles et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Academic Emergency Medicine Volume 20, Issue 1, pages 71–78, January 2013

Guérin et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA). New Engl J Med 2013;epublished May 20th