• Respiratory insufficiency is managed by ensuring a patent airway and assisting ventilation. The most common causes of loss of airway patency and/or respiratory insufficiency are cardiac arrest, impaired consciousness or critical respiratory distress.
• The simplest way to ensure airway patency and to assist ventilation is to open the airway manually and to start assisting ventilation using a bag-mask attached to oxygen.
• The airway must be kept patent and maintained using an airway device, such as an oropharyngeal (oral) or supraglottic airway, an endotracheal tube or by an emergency tracheotomy.
  • An oral airway can be used initially for assisted ventilation with a bag-mask.
  • A supraglottic device should be used as the primary airway device Dynamed.
    • Intubation can be used as the primary method of airway management if there is an experienced intubator present with a high probability of success.
• For emergency tracheotomy i.e. cricothyrotomy, see videos Cricothyrotomy using an intubation tube (emergency tracheotomy) and Cricothyrotomy using a Mini-Trach cannula (emergency tracheotomy).

• In patients with cardiac arrest or impaired consciousness, assisted ventilation should primarily be started using a bag-mask attached to oxygen Dynamed.
• If in hospital, always ask for further assistance according to local guidelines.
• In a health care unit, act according to local guidelines and/or call the emergency number (112) to get support from emergency services for treatment and to have them take the patient for further treatment, as necessary.
• To facilitate bag-mask ventilation, an oral airway should be inserted, as necessary (Image (Insertion of an oral airway)).
  • Choose a size 3–4 oral airway for an adult, a smaller one for a child. The correct length is the distance from the corner of the patient’s mouth to the earlobe.

• Laryngeal mask airway, LMA
  • The correct size depends on the manufacturer and the model.
• Laryngeal tube, LT
  • For choice of size, see Table T1.
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The most common problems

• Placement of the laryngeal mask airway (LMA) does not result in a good seal.
  • Wrongly chosen size of device
  • Device introduced obliquely into the pharynx
  • Fix the problem by reinserting the device.
• The laryngeal tube (LT) does not produce a good seal.
  • Make sure that the cuff is intact and the air volume correct.
  • Check the correct depth (deflate slightly, as necessary, insert at correct depth, fix carefully).

• After inserting the airway device, continue assisted ventilation using a bag attached to the airway device Dynamed.
  • The tidal volume for an adult patient is approx. 500 ml and the respiratory rate 15 per minute.
• Make sure that the patient’s chest rises with each ventilation and that the ventilation is effective (Table T2).

Monitoring devices

• All patients should have
  • 3-lead ECG monitoring
  • expiratory carbon dioxide monitoring (etCO₂, capnograph) with graph display.
• If the patient has a rhythm with pulse, a SpO₂ sensor and automatic pneumatic noninvasive blood pressure (NIBP) monitoring should be used in addition to monitoring the rhythm.