**3. Airway management equipment and techniques in the prehospital setting**

#### **3.1 Mouth to mouth ventilation**

In certain circumstances, when other airway equipment's aren't available this technique can be used initially to maintain oxygenation and ventilation. A barrier should be used to avoid infection transmission [1].

#### *3.1.1 Techniques*

Adults:

Head-tilt/chin-lift to open the airway while pinching the person's nose closed and the hand over his head. The lips have to surround the mouth to create a seal. Start to blow into the person's mouth for one second and watch the chest rise. This maneuver is contraindicated when cervical spine injuries are suspected.

Pediatrics:

Head-tilt/chin-lift to open the airway. The lips have to surround the mouth and nose of the child to create a seal. Blow gently the child's nose mouth for one second. Note that the infant's lungs need a smaller volume of air than an adult., Watch the chest rise while blowing.

#### **3.2 Spontaneous breathing**

It is performed when the rescuer is dealing with a spontaneously breathing patient assisting him to maintain adequate oxygenation and ventilation, with the aid of simple of equipment such as oral or nasal airway devices that can maintain upper airway patency.

Oxygenation can be maintained via simple face mask, nasal cannula or nonrebreathing face mask. Continuous positive pressure ventilation (CPAP) by applying a fitting mask to allow CPAP with spontaneous ventilation can also be implemented in special circumstances when deemed appropriate. This method is found to decrease rates of intubation and mortality [2].

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selected.

*Airway Management in the Pre-Hospital Setting DOI: http://dx.doi.org/10.5772/intechopen.94999*

desaturation during the process of intubation.

**3.4 Oropharyngeal and nasopharyngeal airways**

patients suffering from facial and head injuries.

**3.5 Supra-glottic airway devices (SGA)**

**3.6 Extra-glottic airway devices**

Suction Disposable (iLTS-D).

**3.7 Endotracheal intubation (ETI)**

Supreme, LMA Protector, i-gel (with non-inflatable cuff).

not protect from aspiration and may induce soft tissue trauma.

It is a standard maneuver for initial airway management, the mask applied to the patient's mouth and nose with a properly tight seal being formed between the

It can also be used if endotracheal intubation is planned to avoid oxygen

BMV can be applied by one person using one hand bag mask ventilation technique or by two providers using two hand bag mask ventilation technique in cases were mainting proper seal and proper ventilation becomes difficult.

They are used frequently by prehospital rescuers for spontaneous and assisted breathing to improve both oxygenation and ventilation. They should be avoided in

The oropharyngeal airway device is ideal for use in unresponsive or unconscious

SGA is a broad term for devices which sits above the glottic opening, examples includes laryngeal masks, Proseal LMA, Intubating LMA (ILMA, Fastrach), LMA

The ease of use for non-experienced personnel, makes those devices an appealing option for the use in the out of hospital environment or remote setup. SGA insertion does not require sophisticated skills, it provides proper means of ventilation and oxygenation in unconscious patients. Those features helped the adoption of such devices and increased their use worldwide. Moreover, SGA has become a backup tool in failed intubation in accordance with the difficult airway algorithm by the American Society of Anesthesia (ASA) [3]. Unfortunately, these devices do

These devices have an extra advantage over the other SGA by having large pharyngeal tubes to seal the oropharynx or esophageal balloons to seal the esophagus so they can provide oxygenation and ventilation with reasonable protection from aspiration. They are easy to use and do not require advanced training.

A group of airways includes Laryngeal tube [4], Esophageal tracheal airway (Combitube) which be either inserted in the trachea or esophagus, King laryngeal tube (LT), Rusch EasyTube unlike the Combitube, Intubating Laryngeal Tube

Endotracheal intubation is considered the gold standard method of airway management, which allows proper oxygenation, positive pressure ventilation, positive end-expiratory pressure (PEEP), and protection from gastric content aspiration.

patients who have depressed airway reflexes. Keeping in mind that patient with intact gag reflex might not be able to tolerate the device. On the other hand, The nasopharyngeal airway is usually better tolerated by conscious patients, it is useful also in patients having trauma to oral structures. The proper size should be carefully

patient's mouth and the mask to improve oxygenation and ventilation.

**3.3 Bag-mask-ventilation (BMV)**
