Resuscitation, mouth-to-mouth resuscitation, mouth-to-nose resuscitation English: breathingThe easiest form of resuscitation is “mouth-to-mouth” or “mouth-to-nose” resuscitation. Here the rescuer blows the exhaled air into the patient’s mouth or nose. Accordingly, either mouth or nose is then closed to prevent the air from escaping directly.
It should also be noted that the head should be overstretched. The next best ventilation option is mask ventilation. The patient gets a so-called Guedelt tube in the mouth, which prevents the tongue from falling back.
Then the head is overstretched and the mask is put on. This encloses the mouth and nose. With the simple method of this ventilation, it is now again possible to ventilate with the mouth directly over the mask, but of course the rescue service has resuscitation bags with which the right amount of air is pumped into the lungs.
The bags are also connected to the oxygen cylinder to ensure the best possible ventilation. Ventilation is very safe with this method, but there is no protection against stomach acid running into the lungs. Therefore there are other methods, such as intubation.
In ventilation in the form of endotracheal intubation, a tube is inserted into the trachea and blocked there (fixed by an externally inflatable air cushion). This is supported by a spatula, the laryngoscope. This is used to hold back the tongue during ventilation and the integrated light allows the opening to the trachea to be seen.
The tube can then be connected to the resuscitation bag. This method is the best known method to keep the airways free, to ventilate and to prevent stomach acid from running into the lungs (aspiration). Aspiration protection is ensured by the block.
The air cushion closes the trachea completely, so that air can only enter the lungs through the tube. However, intubation requires a great deal of skill and practice on the part of the person performing it. Even in the emergency service only experienced paramedics or paramedics intubate.
Otherwise it is more likely to be the emergency physician, but only if he or she has mastered the procedure. That is why today there are so-called combination tubes or larynx tubes. These can be inserted with or without a laryngoscope, i.e. also blind.
In this case they end up in the oesophagus in 98% of cases. However, this does not matter, because both tubes have several openings and are also blocked when they are inserted into the oesophagus. One opening is at the end of the part that is to be inserted into the trachea and one above the part that leads into the esophagus.
This means that they can be used for ventilation even when they are in the esophagus and prevent stomach acid from running into the lungs relatively well. As this protection is best provided by endotracheal intubation (see above), the combined or laryngeal tube is usually removed at the clinic and then intubated at rest. If the oral cavity is swollen, for example due to an allergic reaction, it is not possible to intubate and ventilation with the mask is inadequate.
In this case of ventilation, a coniotomy (tracheotomy) is performed. An incision is made just below the thyroid gland (which sits directly on the trachea) in the windpipe and a tube is inserted through this incision. This method is very risky due to the proximity of large vessels in the neck and is therefore only performed in an emergency.
However, it is also used for patients who have to be ventilated for a long time. In this case, however, the risk is lower because the coniotomy can then be performed under safer conditions. Especially not under time pressure.
