Title:
Complex intubation, cricothyrotomy and tracheotomy
Authors:
R. Leach , S. Hachimi Idrissi , J. Meulemans , K. Monsieurs , O. Vanderveken , V. Vander Poorten
Institutions:
Department of Emergency Medicine, Cliniques St. Jean – St. Jansziekenhuis, Bd du Jardin Botanique 32 Kruidtuinlaan, 1000 Brussels,Belgium; Department of Emergency Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven and KU Leuven Department of Oncology Section Head and Neck Oncology, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Emergency Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
Keywords:
Emergency; airway management; cricothyrotomy; surgical airway; cannot intubate cannot ventilate; tracheostomy; percutaneous
Pages:
103 - 118
Abstract:
Complex intubation, cricothyrotomy and tracheotomy. Successful management of a difficult airway begins with recognizing the potential problem. When the patient cannot breathe spontaneously, oxygenation and ventilation should start first with bag-valve ventilation, with or without an airway adjunct such as a Mayo cannula, followed by an orotracheal intubation attempt, performed by an experienced emergency doctor. If orotracheal intubation fails, a quick decision must be made regarding surgical options. In a “cannot intubate, cannot ventilate” situation, a surgical cricothyrotomy should be considered. When orotracheal intubation is impossible, but bag-valve or laryngeal mask ventilation is possible, an urgent surgical tracheostomy should be performed. In the long run, patients in need of long- term artificial ventilation will need a percutaneous or open tracheostomy. This review provides an update of all aspects of immediate and long-term airway management.
Issue:
Suppl. 26.2, 2016


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Complex intubation, cricothyrotomy and tracheotomy