Reflection: on the use of the ILMA in an entrapped patient

On our arrival at a motor vehicle collision we were presented with an entrapped driver. Patient access was restricted to the patient's head, upper chest and right arm due to door intrusion and patient position. 1. Obstructed 2. Respiratory rate 6 min−1 (despite jaw thrust) and SpO2 70% 3. Pulse 120 4. Unconscious 5. Suspected head and chest injuries due to bull's eye damage to windscreen and collapsed steering wheel The airway was cleared by suction, an oral airway inserted and high-flow oxygen was administered. A low respiratory rate and a nasal cannula EtCO2 reading of 57 mm Hg confirmed hypoventilation. While rescue personnel prepared for rapid extrication, we elected to improve oxygenation and ventilation by inserting an intubating laryngeal mask airway (ILMA) as opposed to the more common South African practise of intubating the patient using an ‘ice pick’ approach, which involves intubating the patient while standing in front of the patient.1 …