Oral intubation in the multiply injured patient: the risk of exacerbating spinal cord damage.
The use of oral intubation during the resuscitation of seriously injured patients has been discouraged because of the fear that this technique may lead to cervical cord damage. We report a retrospective study of the 18-month experience of an emergency department in which oral intubation was the usual method of airway control for victims of blunt trauma. There were 237 injured patients intubated in the ED; 21 patients (8.9%) had cervical cord or bone injury. There were no patients in whom a neurologic loss followed an airway maneuver. Oral intubation was the definitive airway maneuver in 213 patients. There was no statistically significant difference in the type of definitive airway maneuver used (eg, oral intubation, nasal intubation, or cricothyrotomy-tracheotomy) between patients with cervical injuries and patients without such injuries. The risk of spinal cord injury secondary to oral intubation in the seriously injured patient was low in our population. Selection of the method for definitive airway control should be based primarily on the operator's skills and experience rather than the fear of inflicting cervical cord damage.
Rhee
K J
KJ
Division of Emergency Medicine, University of California, Davis, Sacramento.
Green
W
W
Holcroft
J W
JW
Mangili
J A
JA
D000328:Adult; D004630:Emergencies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007440:Intubation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008499:Medical Records; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D009407:Nerve Block; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000209:etiology*