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Care of Intubated Patients in Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Shalvi Mahajan, Komal A Gandhi
Endotracheal intubation is a life-saving advanced airway procedure carried out in a triage area. Due to limited hospital capacity, intubated patients may spend critically important time in triage before being transferred to the appropriate area. A majority of urgent care during this period is provided by the trauma triage team. Therefore, a postintubation holistic management is essential even in the triage area for better outcomes.
Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
The severity of a head injury can be indicated by the score attained (Jennett and Teasdale 1974 and Jennett 2005). A score of 8 or less indicates a severe head injury, and the person will be in a coma. The rhyme ‘If the Glasgow score is 8, then it is time to intubate’ may help you to remember that a GCS score of 8 or below is a serious clinical situation where the person is unconscious. Maintenance of the airway by intubation of the trachea or nasopharyngeal airway using an advanced airway is a specialised clinical skill, performed by advanced practitioners who have undergone training for this procedure. You may, however, be required to observe or assist with this skill in an emergency (for more information, see Chapter 14).
Pre-Hospital Care
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Patient assessment follows the standard <C>ABCDE discussed in detail elsewhere in this manual, beginning with control of catastrophic external haemorrhage. Advanced airway skills are increasingly available, as a result, often but not always, provided by consultants in emergency medicine or anaesthesia. Advanced techniques for intravenous access may also be available as may thoracostomy, thoracotomy and intrathoracic techniques for haemorrhage control. Intraosseous access is increasingly used in patients of all ages.
Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†
Published in Prehospital Emergency Care, 2022
Ian G. Stiell, Justin Maloney, Jon Dreyer, Doug Munkley, Daniel W. Spaite, Marion B. Lyver, Julie E. Sinclair, George A. Wells
Prephospital advanced life support is routinely provided by paramedics to treat patients with chest pain in the United States and in some regions of Canada. Advanced life support includes the ability to provide advanced airway management and intravenous drug therapy. Basic life support includes oxygen administration, electrocardiogram monitoring and the ability to defibrillate and in some cases sublingual nitroglycerin (NTG) and acetylsalicylic acid (ASA). The effectiveness of advanced life support interventions for patients with chest pain has not been clearly demonstrated in the literature. Studies have revealed that paramedics are capable of effectively treating chest pain with the administration of nitroglycerin, ASA, intravenous medications, cardiac monitoring, and more recently 12 lead electrocardiogram performance and interpretation (5–10). Nevertheless, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect important outcomes such as mortality.11
Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Daniel P. Davis, Nichole Bosson, Francis X. Guyette, Allen Wolfe, Bentley J. Bobrow, David Olvera, Robert G. Walker, Michael Levy
Advanced airway management and insertion of an advanced airway are recognized as uncomfortable and potentially painful (73). Thus, an ethical obligation exists to address patient comfort during advanced airway management. In addition, reducing patient anxiety and pain may reduce or prevent brain injury and lower intracranial pressure, which have therapeutic benefits in patients with ischemic or traumatic brain injury (74). Furthermore, anxiolysis, analgesia, and/or paralysis may facilitate ventilation and reduce or avoid perfusion, oxygenation, and ventilation complications during positive-pressure ventilation. Thus, priority should be given to the administration of medication to reduce anxiety and pain. If paralysis is necessary for patient safety, oxygenation, or ventilator asynchrony, then adequate sedation and analgesia must be administered. Prehospital clinicians must monitor and recognize signs of alertness and treat appropriately to maintain adequate level of sedation, particularly with use of neuromuscular blocking agents. However, the adverse effects of these medications must be considered in the risk-benefit analysis. Sedatives and analgesics may reduce sympathetic tone, which may be an integral part of the compensatory response to hypovolemia/hypoperfusion. In addition, many sedative and analgesic agents reduce preload or cause systemic vasodilation, both of which may result in hypotension. Furthermore, some agents have direct cardiac suppressive effects.
Prehospital Trauma Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Sabina Braithwaite, Christopher Stephens, Kyle Remick, Whitney Barrett, Francis X. Guyette, Michael Levy, Christopher Colwell
Evidence suggests that the location (i.e., prehospital vs. shortly following hospital arrival) of advanced airway management may be associated with patient outcomes. While some studies found that in-hospital intubation is associated with better outcomes compared with prehospital intubation (22, 23), others found that location of intubation was not associated with mortality or early ventilator-acquired pneumonia in spite of increased intensive care unit, mechanical ventilation, and hospital length of stay (24). A military study noted lower survival for prehospital as compared to emergency department intubation (22). Hawkins et al. evaluated 288 intubated pediatric trauma patients and noted that overall mortality was highest in the more severely injured scene intubation group (29.7%) as compared with those intubated at the referring hospital or pediatric trauma center, but age, injury severity, and neurologic status were more associated with mortality than the intubation location (25).