Prehospital pediatric endotracheal intubation performance review.
Pediatric prehospital care was reviewed over a one-year period to determine success rate, causes of unsuccessful attempts, and complications of performing endotracheal intubation. The Milwaukee County Emergency Medicine Technician-Paramedics (EMT-Ps) responded to 1467 pediatric (less than 19 years of age) patient calls. This accounted for 11% of the patients who received EMT-P care during the study period. Of the 63 patients requiring pediatric endotracheal intubation, 49 (78%) were successfully intubated. Of the 42 pulseless nonbreathing (PNB) patients, 39 (93%) were successfully Of the 21 patients judged to be in impending respiratory failure, 10 (48%) were successfully intubated. Common difficulties in intubating the PNB patient included inability to visualize the glottis and cords secondary to mucus and/or vomitus, use of inappropriately small endotracheal tubes, and accidental extubation during transport. Difficulties in intubating impending respiratory failure patients included patient resistance and seizure activity. We recommend that the EMT-P training curriculum include a review of these difficulties and that prehospital pediatric endotracheal intubation performance be monitored and reviewed with the EMT-Ps.
Losek
J D
JD
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53233.
Bonadio
W A
WA
Walsh-Kelly
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C
Hennes
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Smith
D S
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Glaeser
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PW
D000293:Adolescent; D000488:Allied Health Personnel; D002648:Child; D002675:Child, Preschool; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D012131:Respiratory Insufficiency / Q000628:therapy; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D013398:Sudden Infant Death / Q000628:therapy; D014922:Wisconsin; D014947:Wounds and Injuries / Q000628:therapy