Airway management of aeromedically transported trauma patients.
The airway management of 176 consecutive traumatized patients aeromedically transported from the scene of injury was reviewed. In particular, the frequency of performance and time requirements for both blind nasotracheal intubation and cricothyrotomy were analyzed. Airway control was attempted in 70 (39.5%) patients and successful in 67 (95.7%). The average scene Glasgow Coma Scale (GCS) score of these 70 patients was 7.16 (SD = 3.94) and ranged from 3 to 15. For the remaining 106 patients the average GCS was 14.3 (SD = 1.36) and ranged from 6 to 15 (P less than .0005). The scene trauma score (TS) of the two groups was 10.2 (SD = 3.11) and 15.2 (SD = 1.38), respectively (P less than .0005). In the field, blind nasotracheal intubation by an emergency physician (n = 59) or paramedic (n = 3) was successful in 62 of 65 cases (95.1%). The complication rate for this procedure was 4.6%. Cricothyrotomy was performed in two patients. Only three orotracheal intubations were performed. The remaining three patients were nasotracheally intubated in the emergency department. Neuromuscular blockade was not used in either setting. Despite the difference in patient acuity, there was no statistically significant difference in scene or transport times between those patients emergently intubated and those who were not (P greater than .05).
O'Brien
D J
DJ
Department of Emergency Medicine, University of Louisville, School of Medicine, KY 40292.
Danzl
D F
DF
Sowers
M B
MB
Hooker
E A
EA
D000401:Aircraft; D006259:Craniocerebral Trauma / Q000628:therapy*; D003413:Cricoid Cartilage / Q000601:surgery; D004632:Emergency Medical Services; D005147:Facial Bones / Q000293:injuries; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D009104:Multiple Trauma / Q000628:therapy*; D012887:Skull Fractures / Q000628:therapy; D014187:Transportation of Patients / Q000379:methods*; D014218:Triage