Zusammenfassung
Die Sicherung und Kontrolle der Atemwege bei Notfallpatienten gehören zu den zentralen Erfordernissen einer suffizienten Therapie. Daraus ergibt sich die Forderung, dass die zur Verfügung stehenden Verfahren und Techniken in der Notfallsituation rasch und zuverlässig anwendbar sein müssen. Die gesamten Maßnahmen zur Sicherung der Atemwege sind ohne eine zwischengeschaltete Beatmung und Oxygenierung des Patienten auf 30 s zu begrenzen. Die endotracheale Intubation wird häufig als sog. Goldstandard zur Sicherung der Atemwege bei der Versorgung von Notfallpatienten bezeichnet. Zusätzliche Kenntnisse alternativer Verfahren und die Fähigkeit, diese in einer Notfallsituation durchzuführen, sind jedoch für jeden Notarzt essenziell. Als Ziel aller Maßnahmen muss der Notarzt vor allem die Oxygenierung des Patienten sicherstellen. Vielfache erfolglose Intubationsversuche führen nicht zum Ziel, sondern gefährden den Patienten durch die fortdauernde Hypoxie und die zunehmende Traumatisierung der oberen Luftwege. Wegen der großen Vielfalt der zur Verfügung stehenden Techniken bedarf es eines planmäßigen und umsichtigen Vorgehens im Rahmen eines Algorithmus.
Abstract
Securing the airways in emergency patients are among the key requirements of appropriate emergency care. Besides taking patient-specific anatomical and functional problems into account, it is important to consider difficulties that may arise in an emergency setting, as in the case of trauma or inflammatory disease of the upper respiratory tract. It is imperative, then, that the available processes and techniques are applied quickly and reliably in an emergency situation. The entire range of measures needed to secure the airways, without intermediate ventilation and oxygenation, are limited to 30 seconds. Endotracheal intubation is often called the “gold standard” for airway management in emergency patients. The knowledge of alternative procedures and the ability to carry them out are essential for every emergency physician. Maintaining oxygenation of the patient is the key objective of all measures taken by the emergency physician. Multiple failed attempts at intubation do not achieve this goal; instead, they endanger the patient by prolonging hypoxia and causing additional trauma to the upper airways.
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Interessenskonflikt
Der Autor Dr. Andreas Thierbach hat von den Firmen Karl Storz GmbH & Co. KG sowie Teleflex Medical (ehemals Rüsch) Unterstützungen für Studien erhalten.
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Thierbach, A., Piepho, T. & Kreimeier, U. Sicherung der Atemwege beim Notfallpatienten. Notfall Rettungsmed 10, 469–475 (2007). https://doi.org/10.1007/s10049-007-0960-1
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DOI: https://doi.org/10.1007/s10049-007-0960-1