Basic Principles of Trauma Care
Armstrong Milton B. in Lower extremity Trauma, 2006
All victims of blunt trauma undergoing urgent intubation should be regarded as having a cervical spine injury until proven otherwise. Preoxygenation should be performed in trauma patients prior to intubation. Oral endotracheal intubation with manual inline stabilization of the cervical spine is the most rapid and reliable method to secure the airway of the apneic patient. This approach is superior to blind nasal intubation in terms of safety, success rate, time to intubation, and number of attempts required. In the optimal situation, three people are necessary to perform a successful intubation: (i) to perform laryngoscopy and intubation, (ii) to provide cervical spine immobilization, and (iii) to apply cricoid pressure (picture). Suction devices should be readily available prior to an attempt at intubation whenever possible. Pharmacological agents that include shortacting muscle relaxants and sedatives may be given as part of the rapid sequence intubation, which is considered to be the proper approach for urgent intubation in the trauma setup (13).
Preanesthetic evaluation
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
If the patient is not intubated and requires urgent surgery, it is important to remember that the TBI patient is thought to have a full stomach. In addition to this, it is essential to be ready for the possible presence of blood or vomit in the oral cavity. Finally, TBI often goes along with cervical spine injury, and this possibility must always be considered when performing endotracheal intubation in TBI patients. Rapid sequence intubation is recommended with adequate sedative or analgesics, as well as a neuromuscular blocking agent to prevent increasing intracranial pressure during intubation.
Esophageal Foreign Bodies
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Children with witnessed button battery ingestion should have immediate radiographs to assess for battery location. The confirmation of esophageal location should lead to immediate endoscopic removal in an operating room with surgeons and cardiovascular surgeons on standby. If the child has recently ingested food or liquids, rapid-sequence intubation should be used to secure the patient airway prior to removal. Delay in the administration of anesthesia is unacceptable as time is likely a critical factor in determining the severity of battery-induced esophageal injury.
Continuum of Care: A Multiagency Approach to Seamless Warmed Prehospital Whole Blood Resuscitation of a Patient with Noncompressible Truncal Hemorrhage
Published in Prehospital Emergency Care, 2023
Thaddeus J. Puzio, David E. Meyer, Nicolas Heft, Wren Nealy, Lesley Osborn
While proximity to Level I or II trauma centers and transportation time are key factors in survival, another critical element is the early administration of balanced blood products. Trauma patients who present to prehospital personnel or the emergency department with a shock index (heart rate divided by systolic blood pressure) > 0.9 have a significantly higher mortality rate and requirement of massive transfusion (1, 2). In these patients, early prehospital transfusion can sustain life and enable rapid transport to definitive management in the OR (3). While the optimal use of whole blood in the resuscitation of hemorrhagic shock remains undefined, early retrospective data show equivalent or improved resuscitation using less overall blood product and similar rates of transfusion-related adverse events (4, 5). Moreover, rapid sequence intubation in the presence of hemorrhagic shock can be dangerous. Induction medications may exacerbate hypotension, and systolic hypotension prior to intubation is independently associated with postintubation cardiac arrest (6, 7). Because of the dangers associated with intubation in hemorrhagic shock, many trauma surgeons have advocated for emphasizing circulatory management before airway management in such patients (i.e., placing Circulation before Airway in the primary survey ABCs) (8). The targeted resuscitation with blood products prior to intubation by the ground EMS crew may have also helped to avoid a deleterious outcome during a high-risk intervention.
Success of Pediatric Intubations Performed by a Critical Care Transport Service
Published in Prehospital Emergency Care, 2020
Sriram Ramgopal, Sean E. Button, Sylvia Owusu-Ansah, Mioara D. Manole, Richard A. Saladino, Francis X. Guyette, Christian Martin-Gill
Of note, use of induction and NMB was associated with a higher odds of successful ETI. Cardiac arrest may have partially operated as a confounder with respect to induction, as patients in arrest are typically not induced prior to ETI. However, we obtained similar results in a model developed after exclusion of cardiac arrest, further supporting the independent role for induction and NMB in ETI success (results not shown). Use of medications for rapid sequence induction prior to ETI is associated with greater success in adults in the prehospital setting (38, 39). For patients in our study without cardiac arrest, this finding represents an important modifiable risk factor for patients requiring rapid sequence intubation. Further training to prehospital personnel on use of induction agents for pediatric rapid sequence induction for intubation may be associated with improved outcomes.
Delayed Sequence Intubation by Intensive Care Flight Paramedics in Victoria, Australia
Published in Prehospital Emergency Care, 2018
Jacinta Waack, Matthew Shepherd, Emily Andrew, Stephen Bernard, Karen Smith
Rapid sequence intubation (RSI) involves the simultaneous administration of a sedative and neuromuscular blocking agent (NMBA), rendering the patient unconscious and paralyzed and ensuring optimal conditions for endotracheal intubation (1). RSI is utilized to secure and protect the airway in patients with actual or potential airway compromise or significant hypoxia or patients who require control of ventilation such as those with traumatic brain injury (TBI) (1–3). In the aeromedical environment, the decision to intubate a patient may be to prevent deterioration during flight or for safety in a patient who is noncompliant.
Related Knowledge Centers
- Advanced Airway Management
- Anesthesia
- Apnea
- Pulmonary Aspiration
- Tracheal Intubation
- General Anaesthesia
- Pregnancy
- Emergency Physician
- Fasting
- Gastroesophageal Reflux Disease