Airway Management in Accident and Emergency

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls.

Standard intubation in the ICU

Due to secretions, blood, or oedema in the patients’ airways, compromised pulmonary and haemodynamic, as well as limited access to the patients’ head the standard intubation in the ICU is an overall challenging procedure. Planning, preparation, and straight forwarded strategies are therefore mandatory. As a basic measure, sufficient pre-oxygenation should always be performed. Repetitive intubation attempts significantly worsen patients’ outcomes and need to be avoided. As adequate anaesthesia, including full neuromuscular blockade, can facilitate orotracheal intubation, this should be part of the routine. Apnoeic oxygenation during laryngoscopy by oxygen application via a nasal probe seems to be beneficial to prolong time to desaturation. Despite the fact that nowadays orotracheal intubation in the ICU is probably performed using mainly direct laryngoscopy, video laryngoscopes will possibly have increasing value on the ICU. Extraglottic airway devices represent useful tools to ventilate and oxygenate the patients’ lungs in case of an unexpected failed intubation attempt also on the ICU. In order to confirm adequate ventilation, capnography represents the standard of care and has to be a matter of course whenever a patient needs ventilator support on the ICU.