Emergency Physician—Verified Out—of—hospital Intubation: Miss Rates by Paramedics

Jones, James H.; Murphy, Michael P.; Dickson, Robert; Somerville, Geoff G.; Brizendine, Edward J.

doi:10.1111/j.1553-2712.2004.tb02420.x

Cited by 27 publications

(30 citation statements)

References 11 publications

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“…Recent literature has questioned the safety and benefit of out-of-hospital intubation in certain patients, particularly the headinjured trauma patient. 6,7 Two studies also found rates of misplaced ETTs that ranged from unacceptable (25%) 8 to concerning but more in line with earlier literature (5.8%) 9 using hospital rather than field verification of proper placement. Before we determine the true impact of an out-of-hospital intervention on patient outcomes, we need to know whether, and in what settings, the intervention can be performed.…”

supporting

confidence: 64%

An Evaluation of Out-of-hospital Advanced Airway Management in an Urban Setting

Colwell

McVaney

Haukoos

et al. 2005

Academic Emergency Medicine

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Objectives: To determine the success and complication rates associated with endotracheal intubation in an urban emergency medical services (EMS) system. Methods: This study evaluated consecutive airway interventions between March 2001 and May 2001 performed by paramedics from the Denver Health Paramedic Division in Denver, Colorado. Patients were identified and enrolled prospectively with the identification of all patients for whom intubation was attempted. A retrospective chart review of the emergency department (ED), intensive care unit, other hospital records, and the coroner's records was then conducted with the intent of identifying all complications related to attempted intubation, including the placement of each endotracheal tube. Results: A total of 278 patients were included in this study. Of these, 154 (55%) had an initial nasal intubation attempt, and 124 (45%) had an initial oral intubation attempt. Of the 278 patients for whom an intubation was attempted, 234 (84%, 95% CI = 77% to 88%) were reported by paramedics to be successfully intubated. Of 114 nasal intubations reported as successful by paramedics, two (2%; 95% CI = 0.2% to 6%) were found to be misplaced. Of the 120 oral intubations reported as successful by paramedics, one (1%; 95% CI = 0.02% to 5%) was found to be misplaced. Of the 278 patients, 22 (8%; 95% CI = 5% to 12%) had complications; three (1%; 95% CI = 0.2% to 3%) endotracheal tubes were incorrectly positioned, two (0.7%; 95% CI = 0.08% to 3%) of which were undetected esophageal intubations and one (0.4%; 95% CI = 0 to 2%) of which was in the posterior pharynx. Conclusions: Reasonable success and complication rates of endotracheal intubation in the outof-hospital setting can be achieved in a busy, urban EMS system without the assistance of medications. Keywords: endotracheal intubation; urban; complications; prehospital care. ACADEMIC EMERGENCY MEDICINE 2005; 12:417-422. There may be no out-of-hospital intervention other than defibrillation that is as critical to a patient's outcome as airway management. Placement of endotracheal tubes (ETTs) by paramedics in the outof-hospital setting has been considered a standard of care for a long time, and a number of studies have shown this airway technique to be safe 1-3 and to improve survival in a variety of clinical settings. 4,5 A relatively recent increase in the attention focused on out-of-hospital interventions and the effect they have on patient outcomes has raised important issues and called into question some practices, such as endotracheal intubation, that many have considered standard out-of-hospital practice. Recent literature has questioned the safety and benefit of out-of-hospital intubation in certain patients, particularly the headinjured trauma patient. 6,7 Two studies also found rates of misplaced ETTs that ranged from unacceptable (25%) 8 to concerning but more in line with earlier literature (5.8%) 9 using hospital rather than field verification of proper placement. Before we determine the true impact of an out...

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supporting

confidence: 64%

An Evaluation of Out-of-hospital Advanced Airway Management in an Urban Setting

Colwell

McVaney

Haukoos

et al. 2005

Academic Emergency Medicine

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“…Despite the substantial body of research on the safety of paramedic intubation, [4][5][6][7][8][9][10][11][12][13] there was skepticism among participants that intubation failure contributes to a significant proportion of adverse outcomes. Unfortunately, our current data are unable to resolve this issue.…”

Section: Issuesmentioning

confidence: 99%

Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

Bigham

Bull

Morrison

et al. 2011

CJEM

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Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research. RÉ SUMÉLe person-nel des services mé dicaux d'urgence (SMU) doit souvent intervenir dans des contextes difficiles et instables pouvant accroître les risques d'é vé nements indé sirables. Or, les risques pour la sé curité des patients dans ce contexte sont mé connus. Pour remé dier à cette situation, nous avons effectué une analyse documentaire complè te, y compris des é tudes non randomisé es et non contrô lé es, ré alisé des entrevues qualitatives d'informateurs clé s et, avec l'assistance d'un conseil consultatif pancanadien, organisé une table ronde d'une journé e ré unissant 52 experts dans le domaine de la sé curité des patients et des SMU. Le but de cette rencontre é tait d'examiner les recherches disponibles, de discuter des questions touchant la sé curité des patients en milieu pré hospitalier et de discuter des interventions pour amé liorer leur sé curité . Notre principale intention é tait de dé finir les objectifs straté giques pour amé liorer la sé curité des patients dans les SMU. Les participants repré sentaient toutes les ré gions gé ographiques du Canada et incluaient des administrateurs, des é ducateurs, des mé decins, des chercheurs et des experts en sé curité des patients. Les donné es ont é té recueillies à l'aide d'un vote é lectronique et d'analyses qualitatives des discussions. Le groupe d'e...

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“…Hastane öncesin-de bu oran %7 ile %10 arasında bildirilmiştir. [40,41] ETCO 2 takibinin bu alanda etkinliğini araştıran bir çalışmada kullanmayan grupta %23 oranında özefajiyal entübasyon bildirilirken, kullanan grupta bu oran %0 olarak rapor edilmiştir. [27] Başka bir çalışmada kapnografi kullanımı standart haline geldikten sonra özefajiyal entübasyon oranının %0.3'e düş-tüğü bildirilmiştir.…”

Section: ) Akciğerlerin Ve Epigastrik Bölgenin Oskültasyonuunclassified

Capnography Use In The Emergency Department

Çınar

2011

Tr J Emerg Med

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ÖZETKarbondioksit kısmi basıncının solunum sırasında havayolundan ölçülmesine kapnografi denir. İnvaziv olmama avantajına sahip bu yöntemle hastanın metabolik durumu, perfüzyonu ve en önemlisi ventilasyonu hakkında anlık bilgi elde edilebilir. Güncel rehberlerde endotrakeal entübasyonun doğrulanmasında rutin olarak kullanılması önerilen kapnografinin acil serviste daha birçok potansiyel kullanım alanı bulunmaktadır. Bu derlemede, kapnografinin acil servis kullanım alanlarının tartışılması amaçlanmıştır. GirişKarbondioksit (CO 2 ) kısmi basıncının solunum sırasında havayolundan ölçülmesine kapnografi denir. [1] İnvaziv olmama avantajına sahip bu yöntemle hastanın metabolik durumu, perfüzyonu ve en önemlisi ventilasyonu hakkında anlık bilgi elde edilebilir. Anestezide hasta takibinde 20 yıldır rutin olarak kullanılan kapnografinin, [2] acil pratiğinde kullanımı ancak teknolojik gelişmelerin kızılötesi spektrofotometrik yön-temlerle CO 2 analizi yapılmasına olanak sağlamasıyla başla-mıştır. Çünkü bu yöntemle acil servis kullanımına uygun elde taşınabilir ve düşük maliyetli cihazlar üretilmesi mümkün olmuştur (Şekil 1). Acil serviste kapnografi kullanımı koroner perfüzyon basıncının bir göstergesi olarak Kardiyo Pulmoner Resüsitasyon (KPR) çalışmaları ile başlamış, [3] ancak ismini daha çok endotrakeal entübasyonun doğrulanmasıyla duyurmuştur. [4] Fakat son yıllarda acil serviste girişimsel sedasyon analjezi [5] başta olmak üzere, KPR etkinliğinin değer-lendirilmesi, [6] bilinci kapalı hastada ventilasyon takibi, [7] solunum hastalıklarının değerlendirilmesi [8] gibi birçok alanda kullanımı gündeme gelmiştir.Bu derlemenin amacı acil serviste kapnografi kullanım alanlarının detaylı bir şekilde tartışılmasıdır. Ancak bunun ön-cesinde, acil tıp için yeni olan bu konuda, altta yatan temel kavramların bilinmesine ihtiyaç vardır. Bu nedenle yazının ilk bölümleri okuyucu için sıkıcı olmamasına özen gösterilerek CO 2 fizyolojisi, CO 2 ölçüm yöntemleri, terminoloji ve teknoloji konularına ayrılmıştır. Temel Kavramlar CO 2 FizyolojisiAerobik metobolizmanın bir ürünü olarak dokularda üreti-len CO 2 pasif olarak dolaşıma geçer. Metabolizmayı artıran ateş, egzersiz, sepsis, travma, yanık vb. durumlar CO 2 üreti-mini, dolayısıyla atılan CO 2 miktarını da artırır. Bunun yanın-da metabolik ihtiyacın azaldığı hipotermi, sedasyon, paralizi gibi durumlarda üretilen ve atılan CO 2 miktarı da düşer. Dolaşımda CO 2 3 farklı şekilde taşınır. 1) HCO 3 formunda (%70-%80) 2) Plazma proteinlerine bağlı (%10-%20) (çoğunlukla hemoglobin) 3) Serbest olarak (%5-%10). Dolaşımın bozul-80

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Emergency Physician—Verified Out—of—hospital Intubation: Miss Rates by Paramedics

Cited by 27 publications

References 11 publications

An Evaluation of Out-of-hospital Advanced Airway Management in an Urban Setting

An Evaluation of Out-of-hospital Advanced Airway Management in an Urban Setting

Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

Capnography Use In The Emergency Department

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