The endotracheal tube is a guaranteed mechanism to secure a compromised airway, limit aspiration, and bring about mechanical ventilation in comatose patients. The endotracheal tube is a great method for patients who are comatose, have an obstructed airway, or need mechanical ventilation. The endotracheal tube also allows suctioning of the lower respiratory tract. Drugs that can be inserted through the endotracheal tube during cardiac arrest are discouraged. Before intubation, patients need correct patient positioning and ventilation with 100% oxygen. The purpose of ventilation with 100% oxygen is to denitrogenate healthy patients and prolong the safe apneic time. Tubes with an internal diameter of over 8mm are acceptable for most adults. Insertion technique includes visualizing the epiglottis, the posterior laryngeal structure, and not passing the tube unless tracheal insertion is ensured. Surgical airway
Surgical entry is required when the upper airway is obstructed by a foreign body, massive trauma has occurred, or if ventilation cannot be accomplished by any of the aforementioned methods. The requirement of the surgical airway is commonly known as the response to failed intubation. In comparison, surgical airways require 100 seconds to complete from incision to ventilation compared to laryngeal mask airways and other devices. During emergency cricothyrotomy, the patient lies on his back with neck extended and shoulders backward. The larynx is held in one hand by the practitioner while the other hand is holding a blade to incise the skin through the subcutaneous tissue and into the midline of the cricothyroid membrane to access the trachea.
Initial assessment also involves checking for a pulse, by placing two fingers against the carotid artery, radial artery, or femoral artery to ensure this is purely respiratory arrest and not cardiopulmonary arrest. Checking a pulse after encountering an unresponsive patient is no longer recommended for non-medically trained personnel. Once one has determined that the patient is in respiratory arrest, the steps below can help to further identify the cause of the arrest. Clearing and opening the upper airway
The first step to determining the cause of arrest is to clear and open the upper airway with correct head and neck positioning. The practitioner must lengthen and elevate the patients neck until the external auditory meatus is in the same plane as the sternum. The face should be facing the ceiling. The mandible should be positioned upwards by lifting the lower jaw and pushing the mandible upward. These steps are known as head tilt, chin lift, and jaw thrust, respectively. If a neck or spinal injury is suspected, the provider should avoid performing this maneuver as further nervous system damage may occur. The cervical spine should be stabilized, if possible, by using either manual stabilization of the head and neck by a provider or applying a C-collar. The C-collar can make ventilatory support more challenging and can increase intracranial pressure, therefore is less preferable than manual stabilization. If a foreign body can be detected, the practitioner may remove it with a finger sweep of the oropharynx and suction.