To: ACAD_AE_MED
There is a lot of discussion about rapid sequence induction both in
pre-hospital care and in the A&E department. Here is some
evidence as to why we need to do it. Of course the next step is
who should do it - simple answer the first person there who is
appropriately trained person and can perform RSI safely.
Matthew
Authors
Li J. Murphy-Lavoie H. Bugas C. Martinez J. Preston C.
Institution
Accident Room, Charity Hospital, New Orleans, LA, USA.
Title
Complications of emergency intubation with and without
paralysis.
Source
American Journal of Emergency Medicine.
17(2):141-3, 1999 Mar.
Abstract
Expert and definitive airway management is fundamental to the
practice of emergency medicine. In critically ill patients,
rapid sedation and paralysis, also known as rapid-sequence
intubation, is used to facilitate endotracheal intubation in
order to minimize aspiration, airway trauma, and other
complications of airway management. An alternative method of
emergent endotracheal intubation, intubation minus paralysis,
is performed without the use of neuromuscular blocking
agents. The present study compared complications of these
two techniques in the emergency setting. Sixty-seven
intubations minus paralysis were prospectively compared with
166 rapid-sequence intubations. Complications were
greater in number and severity in the nonparalyzed group and
included aspiration (15%), airway trauma (28%), and
death (3%). None of these difficulties were observed in the rapid-
sequence group (P < .0001). These results show that
rapid-sequence intubation when compared with intubation
minus paralysis significantly reduces complications of
emergency airway management and should be made available
to emergency physicians trained in its use.
Dr Matthew Cooke
Senior Lecturer in Emergency Care
Emergency Medicine Research Group
Primary Care Unit, Univ of Warwick
Tel 024 76 573005 Fax 0870 055 8087
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