Advanced airway control in trauma resuscitation.

McBrien, M E; Pollok, Antony; Steedman, D J

doi:10.1136/emj.9.2.177

Cited by 16 publications

(12 citation statements)

References 2 publications

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“…8 McBrien et al described 25 trauma patients in the ED intubated with RSI (pentobarbital and succinylcholine) with several episodes of transient hypotention and two episodes of prolonged intubation. 18 Recent articles using RSI in the ED have studied larger populations and shown little risk of adverse events. Dufour et al described 219 intubations at a community hospital.…”

Section: Discussionmentioning

confidence: 99%

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Tayal

Riggs

Marx

et al. 1999

Academic Emergency Medicine

201

142

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Abstract. Objectives: Rapid-sequence intubation (RSI) is an active airway intervention used frequently in emergency medicine (EM). The authors hypothesized that RSI can be performed safely in the setting of an EM training program at a tertiary care center. Methods: Observational study of RSI at an urban ED/Level 1 trauma center with annual census of 100,000 patients. Consecutive patients who underwent RSI during a two-year period were studied. Data included age, gender, type of patient (medical/ trauma), indication for intubation, number of intubation attempts (laryngoscope passes), training level of operator, and major immediate adverse events (clinical deterioration within 10 minutes of RSI). Results: RSI was used in 417 of 596 (70%) critically ill patients requiring emergent intubation. The patient demographic distribution was the following: adults 89.7%, male 58%, and trauma 44%. Primary indications for intubation among RSI patients were as follows: mechanical ventilation 57.4%, airway protection 41.3%, and cardiac arrest 1.3%. Distribution of intubations by level of EM training was PGY1, 5%; PGY2, 52%; PGY3, 40%; and attendings, 3%. Intubations were successfully completed within two attempts in 97% of the patients. Major immediate adverse events were encountered in six patients (1.4%) (hypotention = 2, hypoxemia = 1, dysrhythmia = 3). There was no death attributable to RSI. The rate of intubations requiring two or fewer attempts and without major immediate adverse events was 96%. Three patients required cricothyrotomy. Conclusion: In the setting of an EM residency at a tertiary care ED, RSI can be performed successfully with few major immediate adverse events. Key words: intubation; emergency; RSI; residency; adverse events; success rate. ACADEMIC EMERGENCY MEDICINE 1999; 6:31 -37 R APID-sequence intubation (RSI) continues to garner wide acceptance in the emergency setting.1,2 Advantages, such as decreased risk of aspiration, attenuation of intracranial pressure (ICP), avoidance of cardiovascular compromise, and increased patient comfort, have rendered RSI the method of choice for the emergency airway. 2 -7 In addition, RSI can facilitate the difficult intubation in combative patients.3,8 However, RSI is not without risk, particularly if the airway cannot be readily secured and adequate ventilation cannot be provided.

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Section: Discussionmentioning

confidence: 99%

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Tayal

Riggs

Marx

et al. 1999

Academic Emergency Medicine

201

142

View full text Add to dashboard Cite

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“…14,17,40,62,80,81 Studies describing patients managed by ground EMS crews and a receiving trauma center staff indicate that the rate of tracheal intubation is 13.6%, but varies from 11% to 30%. 19,22,67,82 It is clear that trauma patients with acute respiratory system insufficiency commonly have critical injuries, may need tracheal intubation, and develop adverse clinical outcomes. However, there is substantial variation in injury severity, mortality rates, and frequency of intubation.…”

Section: Statement Of the Problemmentioning

confidence: 99%

“…14,17,18,22,26,30, 32,34, 38,44,48,50,64,74,80,88,111,115,144,229 -236 Additional studies describe the details of trauma patients who had emergency OTI where some received drugs assistance (1,967) and others did not (544). 14,19,24,26,37,39,40,45,48,49,68,73,75,228,237 In another 2,887 patients who had OTI, some received drug-assistance and others did not. 19,21,23,27,38,42,57,63,78,81,89,109,113,116,118,119,145,198,228,238,239 However, the number of patients receiving drugs was not stated in the publications.…”

Section: Scientific Evidence For Emergency Orotracheal Intubation In mentioning

confidence: 99%

“…203 Fourteen investigators indicate that a drug regimen used to enhance OTI success should include the need to prevent hemodynamic instability. 14,19,24,32,38,40,49,81,144,229 -231,235,236 Multiple authors indicate that a drug regimen used to enhance OTI success should include the need to prevent vomiting 14,19,24,26,32,37,38,40,80,229,230,233,236 and the extrusion of intraocular contents. 18,24,37,40,81,233 Nine investigators have described OTI in 285 patients with cervical spine injury without neurologic deterioration.…”

Section: Guidelines For Emergency Tracheal Intubationmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for Emergency Tracheal Intubation Immediately after Traumatic Injury

Dunham

Barraco

Clark

et al. 2003

The Journal of Trauma: Injury, Infection, and Critical Care

147

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“…1 In some emergency departments (EDs) in the United Kingdom (UK) there is an increasing trend for advanced emergency airway management (with anesthetic and neuromuscular blocking drugs) to be a shared responsibility between emergency physicians (EPs) and anesthetists. 2,3 In such EDs, anesthetists will usually be called prior to rapid sequence intubation (RSI), and the anesthetist and EP will determine by consensus the most appropriate intubator from the 2 specialties. In the event that the duty anesthetists are occupied with other cases, and if there is a clinical requirement for immediate RSI, the anesthetists will be notified but the EP, if appropriately trained, may proceed with RSI independently.…”

Section: Introductionmentioning

confidence: 99%

Laryngoscopic views during rapid sequence intubation in the emergency department

Graham

Oglesby

Beard

et al. 2004

CJEM

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Objectives: Our objective was to document and compare the views obtained at laryngoscopy during emergency department (ED) rapid sequence intubation (RSI) by anesthetists and emergency physicians of varying seniority and experience. Methods: Data were prospectively collected on every intubation attempt in 7 urban Scottish EDs for 2 calendar years, commencing Jan. 11, 1999. Data included patient's age, gender, grade and specialty of intubator, laryngoscopic grade, and number of intubation attempts. Quality of laryngoscopic visualization was graded using the Cormack-Lehane scale, with grades I and II considered good visualization. A descriptive analysis was performed, and key statistical comparisons made. Results: During the study period, 735 patients underwent RSI, and grade of intubation was documented in 672 cases (91%). In total, 68.2%, 23.4%, 6.1% and 2.4% of the intubations were classified as Cormack-Lehane grade I, II, III and IV respectively. Overall, anesthetists and anesthesia trainees achieved good laryngoscopic visualization in 94.0% of cases (95% confidence interval [CI], 90.8%-96.4%) and emergency physicians and emergency medicine trainees did so in 89.2% of cases (95% CI, 85.5%-92.3%; p = 0.027). Specialist registrars and senior house officers in anesthesia were more likely to obtain good visualization than their emergency medicine counterparts (p = 0.034 and 0.035 respectively). Consultants in emergency medicine were more likely to obtain good views than their anesthesia counterparts, but this difference was not statistically significant. Conclusions: Anesthetic trainees obtain better laryngoscopic views than emergency medicine trainees, but these differences disappear with increasing emergency physician seniority, suggesting a training and experience effect. Emergency medicine trainees may benefit from additional focus on laryngoscopic visualization techniques early in their training period. EM ADVANCES • INNOVATIONS EN MU

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Advanced airway control in trauma resuscitation.

Cited by 16 publications

References 2 publications

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Guidelines for Emergency Tracheal Intubation Immediately after Traumatic Injury

Laryngoscopic views during rapid sequence intubation in the emergency department

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