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Management of emergencies and cardiopulmonary resuscitation
Airway
and Breathing
Cardiac Arrest and Inadequate Circulation
Ventilation
and intubation
If you are faced with a patient who is not breathing:
| 1 |
Open
the airway, then ventilate using a self-inflating bag
and tight fitting mask, with an oral airway if necessary. |
| 2 |
Unless
there is immediate recovery, intubate the trachea and
continue ventilation with the bag. Always add oxygen
if it is available. |
| 3 |
If
the patient is breathing and has a clear airway, ask
yourself if intubation is really needed. The reasons
for intubation under these circumstances would be:
| • |
Need
to protect the airway by avoiding aspiration
of the stomach contents into the lungs |
| • |
Need
to proceed to anaesthesia and surgery for some
additional condition that requires immediate
attention. For example, a patient with severe
facial trauma who is awake, who has a clear airway,
is breathing adequately and is not in hypovolaemic
shock will need intubation later, when the operating
room has been prepared for surgery. This situation
is one where you should use the ABC framework
to anticipate where problems might occur as treatment
proceeds and anaesthesia and surgery are carried
out. |
|
The
laryngeal mask airway (LMA) is a new device that has an
important role in emergency airway management.
Always check that the chest is rising and falling symmetrically
with each squeeze of the bag. Note the pressure needed to inflate
the lungs: if it is increasing that may indicate a lung problem
such as aspiration, bronchospasm or pneumothorax. You must
continue with ventilation until the patient starts to breathe
adequately or a decision is made to stop CPR.
If a cardiorespiratory arrest occurs during an operation, make
sure that the anaesthetic agents have been turned off and you
are ventilating with the highest possible percentage of oxygen.
In emergencies: look – feel – listen.
Airway
and Breathing
Cardiac Arrest and Inadequate Circulation
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