Care of the intubated emergency department patient.
BACKGROUND
Emergency physicians perform tracheal intubation and initiate mechanical ventilation for critically ill patients on a daily basis. With the current national challenges of intensive care unit bed availability, intubated patients now often remain in the emergency department (ED) for exceedingly long periods of time. As a result, care of the intubated patient falls to the emergency physician (EP). Given the potential for significant morbidity and mortality, it is crucial for the EP to possess the most current, up-to-date information pertaining to the care of intubated patients.


CONCLUSIONS
This article discusses critical aspects in the ED management of intubated and mechanically ventilated patients. Specifically, emphasis is placed on providing adequate sedation and analgesia, limiting the use of neuromuscular blocking agents, correctly setting and adjusting the mechanical ventilator, utilizing appropriate monitoring modalities, and providing key supportive measures. Despite these measures, inevitably, some patients deteriorate while receiving mechanical ventilation. The article concludes with a discussion outlining a step-wise approach to evaluating the intubated patient who develops respiratory distress or circulatory compromise. With this information, the EP can more effectively care for ventilated patients while minimizing morbidity, and ultimately, improving outcome.


CONCLUSIONS
Essential components of the care of intubated ED patients includes administering adequate sedative and analgesic medications, using lung-protective ventilator settings with attention to minimizing ventilator-induced lung injury, elevating the head of the bed in the absence of contraindications, early placement of an orogastric tube, and providing prophylaxis for stress-related mucosal injury and deep venous thrombosis when indicated.
Wood
Samantha
S
Combined Emergency Medicine/Internal Medicine/Critical Care, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
Winters
Michael E
ME
D000698:Analgesia; D016292:Procedural Sedation / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008991:Monitoring, Physiologic; D019148:Neuromuscular Blockade; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*
D006993:Hypnotics and Sedatives