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Abstract

Adequate oxygenation at all times is of paramount importance to the critically injured patient to avoid secondary damage. The role of endotracheal intubation in out-of-hospital advanced trauma life support, however, remains controversial. Initiated by a recent observational study, this commentary discusses risks and benefits associated with prehospital intubation, the required personnel and training, and ethical implications. Recent evidence suggests that comprehensive ventilatory care already initiated in the field and maintained during transport may require the presence of a physician or another adequately skilled person at the scene. Benefits of such as service need to be balanced against increased costs.

Analisi delle competenze infermieristiche nei servizi di emergenza preospedaliera: i risultati di un’indagi- ne multicentrica italiana

“…L'intubazione endotracheale, con l'obiettivo di garantire un adeguata ossigenazione e prevenire l'aspirazione di materiale gastrico nel paziente in arresto cardiocircolatorio, rappresenta la tecnica ottimale secondo le linee guida ERC 2005; si tratta tuttavia di una manovra non priva di rischi e che dovrebbe essere eseguita da operatori formati e con ottimi livelli di performance 7 . I diversi strumenti per la gestione delle vie aeree dovrebbero essere utilizzati in base alle competenze e alla formazione dei professionistivi 8 . In una recente meta-analisi, la percentuale di successo della manovra di intubazione endotracheale è riportata intorno all'86,3% e sale a oltre il 96% quando associata a farmaci per induzione rapida (RSI, Rapid Sequence Intubation) 9 .…”

Place of tranexamic acid in modern medicine

“…In 2003, they caused the death of 5 million people worldwide, mainly as a result of traffic accidents, and required hundreds of millions of medical services provided in emergency departments [5,6]. In 2019, road accidents accounted for the 7th cause of death in countries with low financial status and 10th in countries with a slightly higher status; in highly developed countries, deaths resulting from traffic accidents were outside the top ten causes of mortality [7,8]. However, regardless of the socio-economical status of the country, the trauma and associated bleeding is the leading cause of mortality and morbidity worldwide [9,10].…”

Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation

“…The emphasis on empiric and timely intervention with oxygen and tracheal intubation in the emergency medical services (EMS) phase of care has been continually emphasized in the literature and published in guidelines for care of this cohort of patients [7,8]. Tracheal intubation for seriously ill, head-injured patients has served as a resuscitative treatment tenet for decades in the pre-hospital environment [9][10][11][12][13][14]. However, it is only recently that this advanced intervention has been comprehensively studied to determine its true effectiveness in the field.…”