[Suffocation attack].

An acute attack of suffocation is a life threatening event which may be fatal within minutes. Since the oxygen stores of the body are small, any interruption of oxygen uptake by the lungs results in immediate anoxia of tissue and in particular in perilous cerebral anoxia. The primary aims in the management of this emergency situation are: (1.) opening of the airways, clearing any obstruction, and keeping airways open; (2.) administration of oxygen and, if possible, assisted ventilation. This "reflex management" will gain time for diagnostic evaluation, for the decision about further management and, in most cases, for safe transport to the nearest emergency hospital. Further emergency measures are required in the case of upper airway obstruction due either to a foreign body or to laryngeal edema caused by local insect stings or anaphylaxis. Occasionally a foreign body obstructing the upper airways can be cleared using the Heimlich maneuver, i.e. rapid inward and upward pressure on the victim's epigastrium. Mild forms of laryngeal edema can be relieved by inhalation of epinephrine. If these methods fail, cricothyroidotomy or transtracheal ventilation must be performed. Patients with acute severe asthma must be immediately treated with inhalations of a beta-agonist, parenteral prednisolone and administration of oxygen, while emergency transport to the nearest hospital must be organized. To ensure first aid the emergency physician must be equipped with the necessary instruments such as a small oxygen cylinder, appropriate cannula with connectors and tubings for transtracheal ventilation, and a suitable bag-valve-mask device.