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Management of difficult intubation in the prehospital emergency care
SKLENKOVÁ, Hana
The thesis deals with the management of difficult intubation in pre-hospital emergency care. In the context of a difficult intubation it tries to solve the issue of difficult airways management when dealing in such arduous situations. Within the interim legislation a paramedic is not qualified to perform the actual endotracheal intubation, by ordinance No. 55/2011 statue book which determines activities of medical staff and other professionals. Except in extreme emergency situations. (29) Despite of this, he is expected to know all the procedures and master these functions mainly in emergency situations when he must assist a doctor. The aim of this work was to set out the possibilities of solving difficult intubation in pre-hospital emergency care with a focus on competence of a paramedic. But during the research process I reached the view that, taking into consideration the interim legislation and the attitude of paramedics to this issue, it will be more suitable to map out the experience and knowledge of paramedics related to the management of a difficult intubation and airways management. In the theoretical part I tried to approach the issue of difficult intubation and with that, of course, airways management. The part of the procedure of solving difficult intubation, which it is not in the competence of paramedic, is also the use of alternative tools that every paramedic should manage. The research was carried using a qualitative method in the form of a structured interview. The interview was conducted with paramedics who were randomly selected in various regional centers of the Emergency Medical Services in South Region. The research group consisted of thirteen respondents of different gender, age and length of service. Respondents were asked 11 questions, which surveyed the attitudes of paramedics to the issue of difficult airways management. The questions concerned the experience of these states, their options and also verified general knowledge of whether paramedics are theoretically prepared to tackle difficult intubation and difficult airways management in pre-hospital emergency care. When processing data from the research I concluded that the approach to the issue of paramedics' difficult airways management is not as responsible as it should. Although paramedics met with difficulty in ensuring the airway, it was usually the doctors who solved these states. In the majority opinion, the paramedics agreed that for the time being using the laryngeal mask is sufficient or, if need be, they call the doctor. But if the doctor was not available, it is not certain whether they would be able to handle the situation themselves, because their theoretical knowledge is not always sufficient. As a positive outcome of my research was finding that most of the paramedics did not object to further practical and theoretical training in this direction and that there are some individuals who are privately educated in this area.The thesis can be beneficial for students in the paramedic field and also specialized healthcare professionals to bring together information on airway management. Part of the thesis is also a DVD-ROM complete with video attachments.
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Options airway paramedics in terms of prehospital emergency care
KOZELKA, Pavel
This bachelor thesis deals with establishing an airway by a paramedic service in terms of pre-hospital emergency care. Considering unexpected accidents and life-threatening situations, securing the airway is one of the most important performances in pre-hospital care. Proper airway securing covers both effective ventilation and oxygenation. It is not always possible to secure using usual techniques. Therefore, alternative methods of airway management are introduced in this thesis as well. The theoretical part is concerned with the airway management. The first chapter aims at the historical background and describes the development of airway securing techniques. Following parts provide with a short introduction to the anatomy and physiology of the human respiratory tract. The thesis describes the concept of pre-hospital care and competencies of a paramedic. It focuses on airway management with or without medical devices and characterizes the main techniques, such as, the oral cavity examination, head-tilt method, the triple airway manoeuvre and Heimlich and Gordon manoeuvres. Regarding airway devices, the thesis mentions pharyngeal airway, combitube, laryngeal tube and laryngeal mask, I-gel, endotracheal intubation and alternative airway securing including coniotomy and laryngectomy. The last chapter of the theoretical part deals with the modes of artificial ventilation. The practical part compares the options of airway management and monitors the level of theoretical knowledge of airway establishing among emergency paramedics in South Bohemia, Central Bohemia and Pilsen Region.
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Clearing the airway by an emergency care provider in the prehospital emergency care
NOVOTNÁ, Magdalena
Clearing an obstructed airway to facilitate breathing is a critical element of airway management. It is the emergency care provider who administers first aid and he/she has to master the technique of opening the airway as well as the aspiration prevention. The right airway management may avert the life-threatening condition of an injured person. The thesis is focused on the possibilities of clearing the airway by the emergency care provider in the Central Bohemian region. Techniques of opening and clearing the airway both without or with aids, which are at the emergency care provider´s disposal in prehospital care, are mentioned. The research set was formed by emergency care providers in transit first-aid stations providing emergency care in the Central Bohemian region. The research was conducted by the quantitative method. To collect data, the questionnaire method was used. I handed out 100 questionnaires in transit first-aid stations in the Central Bohemian region. The research was anonymous. The rate of return was 76%, it means I was given back 76 anonymously filled in questionnaires. The objective of the research was to survey possibilities of clearing the airway by the emergency care provider in the Central Bohemian region {--} and the objective was accomplished. The hypothesis I {--} on the part of an emergency care provider the most effective way how to clear the airway is endotracheal intubation {--} was confirmed {--} as well as the hypothesis II - emergency care providers do not use the {\clqq}LMA- Fastrach`` to clear the airways.The conclusions of the thesis may be used in making up standardized methods and techniques of clearing the airway in the prehospital emergency care. They may also be used for further education of university students of nursing and medical care.
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