Emergency airway management--experience of a tertiary hospital in South-East Asia.
OBJECTIVE
To study the indications and diagnoses of patients requiring emergency airway management and to evaluate the adequacy of airway management skills of emergency physicians.


METHODS
Prospective observational study of all patients requiring advanced airway management from 1 November 1998 to 31 October 2002.


RESULTS
There were 1068 cases, 710 (66.5%) were men. The median age was 63 years. The most common diagnoses requiring tracheal intubation were cardiopulmonary arrest (37.7%), congestive heart failure (20.8%) and head injury (8.3%). The main indications were apnoea (42.5%), hypoxia (21.3%) and prophylactic airway protection (17.6%). Orotracheal intubation with no medication was most common (51.5%) followed by rapid sequence induction (RSI) (28.4%) and orotracheal intubation with sedation only (19.6%). The overall success rate for orotracheal intubation was 99.6%. The cricothyrotomy rate was 0.2%. Hypotension (4.2%), multiple intubation attempts (1.9%) and oesophageal intubation (1.5%) were the three most common peri-intubation complications. There was no statistical difference in the occurrence of hypotension between the use of midazolam and etomidate for sedation or induction prior to intubation. Six hundred and forty-six (60.5%) patients survived the immediate post-resuscitation period. No patient died from failure to secure the airway.


CONCLUSIONS
Airway management and rapid sequence induction for intubation can be safely performed by emergency physicians.
Wong
Evelyn
E
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. gaeeve@sgh.com.sg
Fong
Yuke Tien
YT
Ho
Khoy Kheng
KK
D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage; D002648:Child; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007022:Hypotension / Q000209:etiology; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage; D012151:Resuscitation
D000777:Anesthetics; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents