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Intubation bei präklinischen Notfällen und im Schockraum

Intubation in preclinical emergencies and the resuscitation room

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Zusammenfassung

Bei Präoxygenierung sollte Sauerstoff mit hohem Fluss über eine eng anliegende Maske mit Reservoir verabreicht werden. Beim hämodynamisch instabilen Patient ist zur Narkoseeinleitung Ketamin Mittel der Wahl. Ein erfahrener Helfer kann präklinisch eine Anästhesieeinleitung erwägen. Ein wenig geübter Helfer sollte auf eine Intubation verzichten, die Oxygenierung optimieren, den Krankenhaustransport beschleunigen und nur in Extremfällen Maskenbeatmung oder einen supraglottischen Atemweg einsetzen. Bei erwartet schwieriger Intubation sollte der Patient fiberoptisch wach intubiert werden. Bei unerwartet schwieriger Intubation sollten Maskenbeatmung oder ein supraglottischer Atemweg eingesetzt werden. Erfahrene Hilfe sollte rechtzeitig gerufen werden. Kann weder beatmet noch intubiert werden, sollte ein supraglottischer Atemweg und bei Misserfolg ein chirurgischer Atemweg angestrebt werden. Die Beatmung sollte mit Kapnometrie kontinuierlich überwacht werden. Kontinuierliches klinisches Training ist für ein gutes Atemwegsmanagment essenziell.

Abstract

For pre-oxygenation high-flow oxygen should be delivered with a tight fitting face mask provided with a reservoir. In hemodynamically unstable patients ketamine is the induction agent of choice. An experienced health care provider may consider prehospital induction of anesthesia. A less experienced health care provider should refrain from intubation, optimize oxygenation, accelerate hospital transfer and only in extreme situations ventilate with a bag-valve mask or a supraglottic airway device. With an expected difficult airway the patient should be intubated awake. With an unexpected difficult airway bag-valve mask ventilation should be resumed and an alternative supraglottic airway device inserted. Experienced help should be summoned early. In a“cannot ventilate, cannot intubate” situation an alternative airway should be attempted and if unsuccessful a surgical airway should be performed. Ventilation should be monitored continuously with capnography. Clinical training is important to increase airway management skills.

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  1. Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    L. Kühnelt-Leddihn & P. Paal

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  1. L. Kühnelt-Leddihn
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  2. P. Paal
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Correspondence to L. Kühnelt-Leddihn.

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Kühnelt-Leddihn, L., Paal, P. Intubation bei präklinischen Notfällen und im Schockraum. Notfall Rettungsmed 13, 281–286 (2010). https://doi.org/10.1007/s10049-010-1285-z

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  • DOI: https://doi.org/10.1007/s10049-010-1285-z

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