In addition, ETI has the potential to cause secondary injury if performed inadequately or unsuccessfully by creating or exacerbating hypoxia or hypotension. Even for patients that are initially stable, a delay in intubation is associated with increased mortality from 1.8% to 11.8% in one study. Delays in adequate airway management may have devastating consequences, and this is one of the more common causes of preventable death in both the prehospital and the emergency department setting. Therefore, the decision is not only whether a patient needs intubation but also when and how to intubate. It has long been established that any decrease in oxygen delivery to the injured brain, precipitated by hypoxia or hypotension, increases morbidity and mortality in the setting of severe traumatic brain injury. The decision to intubate may go well beyond a patient’s ability to oxygenate or ventilate. One of the most difficult aspects of airway management in trauma is the potential deterioration in clinical status, which may occur during the early phases of resuscitation. However, multiple factors may be present, which make the decision to intubate less straightforward. Patients may require emergency tracheal intubation (ETI) for various reasons following injury including hypoxia, hypoventilation, or failure to maintain or protect the airway owing to altered mental status. The ABCs of trauma resuscitation begin with the airway evaluation, and effective airway management is imperative in the care of a patient with critical injury. The first priority in the care of all trauma patients is the affirmation of a patent airway to ensure adequate oxygenation and ventilation. MD Author Informationįrom the Virginia Commonwealth University Medical Center (J.M., T.M.D., J.W.), Richmond, Virginia Carolinas Medical Center (M.G.), Charlotte, North Carolina University of Pennsylvania (M.C.), Philadelphia, Pennsylvania Kings County Medical Center (E.L.) and Mt Sinai Medical Center (K.H.S.), New York, New York University of Texas Southwestern Medical Center (A.L.E.), Dallas, Texas.Īddress for reprints: Julie Mayglothling MD, Virginia Commonwealth University Medical Center, Richmond, VA email: Introduction MD, MPH Whelan, James MD Shah, Kaushal H. MD Gibbs, Michael MD McCunn, Maureen MD, MIPP Legome, Eric MD Eastman, Alexander L. Exempt Purpose, Mission, Vision & Goals.Interviews with Research Scholarship & Award Recipients.Equity, Diversity, and Inclusion in Trauma Surgery Practice.Landmark Papers in Trauma and Acute Care Surgery.In a particular context a clinician may consider them important to safe conduct of RSI. The optional nature of these elements does not imply that they are inconsequential. They may be incorporated into the practice of RSI at the clinicians discretion. These elements may theoretically contribute to the goals of RSI but their is insufficient evidence to either support or reject their inclusion as elements. These refer to elements contributing to the goals of RSI that should typically be adhered to but which clinicians may legitimately decide to omit in a particular context, while still being able to refer to the technique employed as RSI. The term ‘modified RSI’ should not be used. Any intubation technique including all essential elements can be referred to as RSI, independent of any other variations undertaken. While these other elements might become even more important during RSI and would be expected to be used, they are not defining characteristics of RSI. use of ETCO2 monitoring, pulse oximetry, etc.) may be viewed as essential to all safe airway management practice, irrespective of whether or not RSI was being undertaken. These represent the defining aspects that must be included in order for an intubation technique to be referred to as RSI. These refer to elements on which there is evidence &/or universal consensus on their contribution to the goals of RSI. It does not refer to rushing to reduce the time between the decision to intubate and securing the airway. The term ‘rapid’ refers to minimising the time interval between the pharmacologically induced loss of normal intrinsic airway protective reflexes and protection of the airway via correct placement of a tracheal tube such that an adequate seal with the tracheal wall is obtained (typically by inflation of the cuff). Rapid sequence intubation (RSI) is an intubation technique performed to reduce the risk and consequences of aspiration during tracheal intubation.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |