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Erschienen in: Notfall +  Rettungsmedizin 4/2010

01.06.2010 | Leitthema

Intubation bei präklinischen Notfällen und im Schockraum

verfasst von: Dr. med. univ. L. Kühnelt-Leddihn, P. Paal

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 4/2010

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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.
Literatur
1.
Zurück zum Zitat Timmermann A, Russo SG, Eich C et al (2007) The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 104:619–623 CrossRefPubMed Timmermann A, Russo SG, Eich C et al (2007) The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 104:619–623 CrossRefPubMed
2.
Zurück zum Zitat Ufberg JW, Bushra JS, Karras DJ et al (2005) Aspiration of gastric contents: association with prehospital intubation. Am J Emerg Med 23:379–382 CrossRefPubMed Ufberg JW, Bushra JS, Karras DJ et al (2005) Aspiration of gastric contents: association with prehospital intubation. Am J Emerg Med 23:379–382 CrossRefPubMed
3.
Zurück zum Zitat Tentillier E, Heydenreich C, Cros AM et al (2008) Use of the intubating laryngeal mask airway in emergency pre-hospital difficult intubation. Resuscitation 77:30–34 CrossRefPubMed Tentillier E, Heydenreich C, Cros AM et al (2008) Use of the intubating laryngeal mask airway in emergency pre-hospital difficult intubation. Resuscitation 77:30–34 CrossRefPubMed
4.
Zurück zum Zitat Goedecke A von, Herff H, Paal P et al (2007) Field airway management disasters. Anesth Analg 104:481–483 CrossRef Goedecke A von, Herff H, Paal P et al (2007) Field airway management disasters. Anesth Analg 104:481–483 CrossRef
5.
Zurück zum Zitat Mort TC (2005) Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med 33:2672–2675 CrossRefPubMed Mort TC (2005) Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med 33:2672–2675 CrossRefPubMed
6.
Zurück zum Zitat Jabre P, Combes X, Lapostolle F et al (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 374:293–300 CrossRefPubMed Jabre P, Combes X, Lapostolle F et al (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 374:293–300 CrossRefPubMed
7.
Zurück zum Zitat Morris C, Perris A, Klein J, Mahoney P (2009) Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent? Anaesthesia 64:532–539 CrossRefPubMed Morris C, Perris A, Klein J, Mahoney P (2009) Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent? Anaesthesia 64:532–539 CrossRefPubMed
8.
Zurück zum Zitat Begec Z, Demirbilek S, Onal D et al (2009) Ketamine or alfentanil administration prior to propofol anaesthesia: the effects on ProSeal laryngeal mask airway insertion conditions and haemodynamic changes in children. Anaesthesia 64:282–286 CrossRefPubMed Begec Z, Demirbilek S, Onal D et al (2009) Ketamine or alfentanil administration prior to propofol anaesthesia: the effects on ProSeal laryngeal mask airway insertion conditions and haemodynamic changes in children. Anaesthesia 64:282–286 CrossRefPubMed
10.
Zurück zum Zitat Adnet F, Baillard C, Borron SW et al (2001) Randomized study comparing the“sniffing position” with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology 95:836–841 CrossRefPubMed Adnet F, Baillard C, Borron SW et al (2001) Randomized study comparing the“sniffing position” with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology 95:836–841 CrossRefPubMed
12.
Zurück zum Zitat Weiss M, Gerber AC (2007) Induction of anaesthesia and intubation in children with a full stomach. Time to rethink!. Anaesthesist 56:1210–1216 CrossRefPubMed Weiss M, Gerber AC (2007) Induction of anaesthesia and intubation in children with a full stomach. Time to rethink!. Anaesthesist 56:1210–1216 CrossRefPubMed
13.
Zurück zum Zitat Aufderheide TP, Sigurdsson G, Pirrallo RG et al (2004) Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 109:1960–1965 CrossRefPubMed Aufderheide TP, Sigurdsson G, Pirrallo RG et al (2004) Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 109:1960–1965 CrossRefPubMed
14.
Zurück zum Zitat Herff H, Paal P, Goedecke A von et al (2008) Influence of ventilation strategies on survival in severe controlled hemorrhagic shock. Crit Care Med 36:2613–2620 CrossRefPubMed Herff H, Paal P, Goedecke A von et al (2008) Influence of ventilation strategies on survival in severe controlled hemorrhagic shock. Crit Care Med 36:2613–2620 CrossRefPubMed
15.
Zurück zum Zitat Wenzel V, Idris AH, Dorges V et al (2001) The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics and ventilation strategies for patients with an unprotected airway. Resuscitation 49:123–134 CrossRefPubMed Wenzel V, Idris AH, Dorges V et al (2001) The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics and ventilation strategies for patients with an unprotected airway. Resuscitation 49:123–134 CrossRefPubMed
16.
Zurück zum Zitat Paal P, Neurauter A, Loedl M et al (2009) Effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in pigs. Resuscitation 80:470–477 CrossRefPubMed Paal P, Neurauter A, Loedl M et al (2009) Effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in pigs. Resuscitation 80:470–477 CrossRefPubMed
17.
Zurück zum Zitat Takeda T, Tanigawa K, Tanaka H et al (2003) The assessment of three methods to verify tracheal tube placement in the emergency setting. Resuscitation 56:153–157 CrossRefPubMed Takeda T, Tanigawa K, Tanaka H et al (2003) The assessment of three methods to verify tracheal tube placement in the emergency setting. Resuscitation 56:153–157 CrossRefPubMed
18.
Zurück zum Zitat Mitterlechner T, Maisch S, Wetsch WA et al (2009) A suction laryngoscope facilitates intubation for physicians with occasional emergency medical service experience–a manikin study with severe simulated airway haemorrhage. Resuscitation 80:693–695 CrossRefPubMed Mitterlechner T, Maisch S, Wetsch WA et al (2009) A suction laryngoscope facilitates intubation for physicians with occasional emergency medical service experience–a manikin study with severe simulated airway haemorrhage. Resuscitation 80:693–695 CrossRefPubMed
19.
Zurück zum Zitat (n a) (2003) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 98:1269–1277 (n a) (2003) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 98:1269–1277
20.
Zurück zum Zitat Henderson JJ, Popat MT, Latto IP, Pearce AC (2004) Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59:675–694 CrossRefPubMed Henderson JJ, Popat MT, Latto IP, Pearce AC (2004) Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59:675–694 CrossRefPubMed
21.
Zurück zum Zitat Brimacombe J, Keller C, Boehler M, Puhringer F (2001) Positive pressure ventilation with the ProSeal versus classic laryngeal mask airway: a randomized, crossover study of healthy female patients. Anesth Analg 93:1351–1353 CrossRefPubMed Brimacombe J, Keller C, Boehler M, Puhringer F (2001) Positive pressure ventilation with the ProSeal versus classic laryngeal mask airway: a randomized, crossover study of healthy female patients. Anesth Analg 93:1351–1353 CrossRefPubMed
22.
Zurück zum Zitat Hohlrieder M, Brimacombe J, Goedecke A von, Keller C (2006) Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intubation by first-month anesthesia residents after brief manikin-only training. Anesth Analg 103:458–462 CrossRefPubMed Hohlrieder M, Brimacombe J, Goedecke A von, Keller C (2006) Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intubation by first-month anesthesia residents after brief manikin-only training. Anesth Analg 103:458–462 CrossRefPubMed
23.
Zurück zum Zitat Gaitini LA, Vaida SJ, Somri M et al (2004) A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients. Anesthesiology 101:316–320 CrossRefPubMed Gaitini LA, Vaida SJ, Somri M et al (2004) A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients. Anesthesiology 101:316–320 CrossRefPubMed
24.
Zurück zum Zitat Eich C, Timmermann A, Russo SG et al (2007) Simulator-based training in paediatric anaesthesia and emergency medicine–thrills, skills and attitudes. Br J Anaesth 98:417–419 CrossRefPubMed Eich C, Timmermann A, Russo SG et al (2007) Simulator-based training in paediatric anaesthesia and emergency medicine–thrills, skills and attitudes. Br J Anaesth 98:417–419 CrossRefPubMed
25.
Zurück zum Zitat Winchell RJ, Hoyt DB (1997) Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma research and education foundation of San Diego. Arch Surg 132:592–597 PubMed Winchell RJ, Hoyt DB (1997) Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma research and education foundation of San Diego. Arch Surg 132:592–597 PubMed
26.
Zurück zum Zitat Dick WF (2003) Anglo-American vs. Franco-German emergency medical services system. Prehosp Disaster Med 18:29–35 PubMed Dick WF (2003) Anglo-American vs. Franco-German emergency medical services system. Prehosp Disaster Med 18:29–35 PubMed
27.
Zurück zum Zitat Scott DB (1986) Endotracheal intubation: friend or foe. Br Med J (Clin Res Ed) 292:157–158 CrossRef Scott DB (1986) Endotracheal intubation: friend or foe. Br Med J (Clin Res Ed) 292:157–158 CrossRef
28.
Zurück zum Zitat Lumb A (2007) Nunn’s applied respiratory physiology. 6 th edn. Butterworth-Heinemann (ed), Elsevier Ltd, Philadelphia, PA/USA Lumb A (2007) Nunn’s applied respiratory physiology. 6 th edn. Butterworth-Heinemann (ed), Elsevier Ltd, Philadelphia, PA/USA
29.
Zurück zum Zitat Morgan E, Mikhail M, Murray M (2006) Clinical Anesthesiology. 4 th edn. McGraw-Hill Companies, New York, NY/USA Morgan E, Mikhail M, Murray M (2006) Clinical Anesthesiology. 4 th edn. McGraw-Hill Companies, New York, NY/USA
30.
Zurück zum Zitat Paal P, Herff H, Mitterlechner T et al (2010) Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation 81:148–154 CrossRefPubMed Paal P, Herff H, Mitterlechner T et al (2010) Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation 81:148–154 CrossRefPubMed
Metadaten
Titel
Intubation bei präklinischen Notfällen und im Schockraum
verfasst von
Dr. med. univ. L. Kühnelt-Leddihn
P. Paal
Publikationsdatum
01.06.2010
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 4/2010
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-010-1285-z

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