[How to secure free airway?].
BACKGROUND
To secure the airway has the highest priority when handling critically ill and injured patients. The aim of this article is to present simple and new devices and techniques to secure the airway.


METHODS
The paper is based on international algorithms for optimal treatment of patients with acute airway problems, and the authors' experience from clinical work and organizing of courses.


RESULTS
Unconscious patients have obstructed airways because the tongue slides back and blocks the airway. This can be prevented by lifting the jaw, possibly supplemented by insertion of an oropharyngeal airway. When these active techniques are not used, patients must be placed in the semi-prone position and air passage checked. The non-breathing patient must be ventilated with simple devices: mouth-to-mouth, pocket-mask or face-mask and bag. Endotracheal intubation is difficult and supraglottic devices are easier and safer to handle. Anaesthetists may use special equipment when securing of airway is particularly difficult. Hospitals routinely intubate with bronchoscopy when presented with patients who breathe spontaneously and for whom airway is expected to have very difficult access. Direct transtracheal access can be obtained by emergency tracheotomy or with various puncturing techniques.


CONCLUSIONS
In the unconscious patient, it is of vital importance to maintain a secure airway with simple devices. Hypoxia subsequent to obstructed airways in unconscious patients will become life-threatening, and may cause cerebral ischemia and cardiac arrest within 5-6 minutes. All doctors should be able to ventilate patients with face-mask and bag-valve device. Intubation and tracheotomy should only be performed by trained personnel.
Anestesiavdelingen, Oslo universitetssykehus, Ullevål.
Carl Eivind
CE
Bjerkelund
Per
P
Christensen
Stein
S
Dragsund
Petter
P
Aadahl
D000758:Anesthesia; D001999:Bronchoscopy; D016887:Cardiopulmonary Resuscitation; D016638:Critical Illness / Q000628:therapy*; D004630:Emergencies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D017214:Laryngeal Masks; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012138:Respiratory Therapy / Q000295:instrumentation / Q000379:methods*; D014140:Tracheotomy
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