Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation.
Autor: | Walker RG, White LJ, Whitmore GN, Esibov A, Levy MK, Cover GC, Edminster JD, Nania JM |
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Jazyk: | angličtina |
Zdroj: | Prehospital emergency care [Prehosp Emerg Care] 2018 May-Jun; Vol. 22 (3), pp. 300-311. Date of Electronic Publication: 2018 Jan 03. |
DOI: | 10.1080/10903127.2017.1380095 |
Abstrakt: | Objective: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI. Methods: Electronic patient monitor data files from cases in which paramedic RSI was attempted were prospectively collected over a 15-month study period to supplement the standard EMS patient care documentation. Cases were analyzed to identify peri-intubation changes in oxygen saturation, heart rate, and blood pressure. Results: Data from 134 RSI cases were available for analysis. Paramedic-assigned prehospital diagnostic impression categories included neurologic (42%), respiratory (26%), toxicologic (22%), trauma (9%), and cardiac (1%). The overall intubation success rate (95%) and first-attempt success rate (82%) did not differ across diagnostic impression categories. Peri-intubation desaturation (SpO Conclusions: In this study, the majority of peri-intubation physiologic alterations occurred on first-attempt success, highlighting that first-attempt success is an incomplete and potentially deceptive measure of intubation quality. Supplementing the standard patient care documentation with electronic monitoring data can identify unrecognized physiologic instability during prehospital RSI and provide valuable guidance for quality improvement interventions. |
Databáze: | MEDLINE |
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