Paramedic rapid sequence intubation in patients with non-traumatic coma
Introduction Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic br...
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| Veröffentlicht in: | Emergency medicine journal : EMJ 2015-01, Vol.32 (1), p.60-64 |
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| creator | Bernard, S A Smith, K Porter, R Jones, C Gailey, A Cresswell, B Cudini, D Hill, S Moore, B St Clair, T |
| description | Introduction Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain. Methods The electronic Victorian Ambulance Clinical Information System was searched for the term ‘suxamethonium’ between 2008 and 2011. We reviewed the patient care records and included patients with suspected non-traumatic coma who were treated and transported by road-based paramedics. Demographics, intubation conditions, vital signs (before and after drug administration) and complications were recorded. Younger patients ( |
| doi_str_mv | 10.1136/emermed-2013-202930 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1637573836</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1637573836</sourcerecordid><originalsourceid>FETCH-LOGICAL-b442t-5b1ceb7459ea32ebd91bb548f6b492bbcf5e73a0cecebc96c68cefd53b4a24963</originalsourceid><addsrcrecordid>eNqNkE9LwzAYh4Mobk4_gSAFL14687dpjiI6hYEe9ByS9C12rOlMWsRvb0o3D568JD-S5_3x8iB0SfCSEFbcQguhhSqnmLB0UMXwEZoTLmmOKWHHvxmLGTqLcYMxEYqXp2hGOZeMYzVHq1cTTGppXBbMrqmyCJ8DeAdZ4_vBmr7pfIrZLiXwfcy-mv4j853P-2CGNr26zHWtOUcntdlGuNjfC_T--PB2_5SvX1bP93fr3HJO-1xY4sBKLhQYRsFWilgreFkXlitqrasFSGawg4Q5VbiidFBXglluKFcFW6CbqXcXurRo7HXbRAfbrfHQDVGTgkkhWclG9PoPuumG4NN2msgyyeBC0kSxiXKhizFArXehaU341gTr0bPee9ajZz15TlNX--7Bjn-HmYPYBCwnwLabfzX-AO41ieA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1780014572</pqid></control><display><type>article</type><title>Paramedic rapid sequence intubation in patients with non-traumatic coma</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Bernard, S A ; Smith, K ; Porter, R ; Jones, C ; Gailey, A ; Cresswell, B ; Cudini, D ; Hill, S ; Moore, B ; St Clair, T</creator><creatorcontrib>Bernard, S A ; Smith, K ; Porter, R ; Jones, C ; Gailey, A ; Cresswell, B ; Cudini, D ; Hill, S ; Moore, B ; St Clair, T</creatorcontrib><description>Introduction Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain. Methods The electronic Victorian Ambulance Clinical Information System was searched for the term ‘suxamethonium’ between 2008 and 2011. We reviewed the patient care records and included patients with suspected non-traumatic coma who were treated and transported by road-based paramedics. Demographics, intubation conditions, vital signs (before and after drug administration) and complications were recorded. Younger patients (<60 years) were compared with older patients. Results There were 1152 paramedic RSI attempts of which 551 were for non-traumatic coma. The success rate for intubation was 97.5%. There was a significant drop in blood pressure in younger patients (<60 years) with the mean systolic blood pressure decreasing by 16 mm Hg (95% CI 11 to 21). In older patients, the systolic blood pressure also decreased significantly by 20 mm Hg (95% CI 17 to 24). Four patients suffered brief cardiac arrest during pre-hospital care, all of whom were successfully resuscitated and transported to hospital. Conclusions Paramedic RSI in patients with non-traumatic coma has a high procedural success rate. Further studies are required to determine whether this procedure improves outcomes.</description><identifier>ISSN: 1472-0205</identifier><identifier>EISSN: 1472-0213</identifier><identifier>DOI: 10.1136/emermed-2013-202930</identifier><identifier>PMID: 24473409</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Aged ; Airway management ; Allied Health Personnel ; Anesthesia ; Coma - etiology ; Drug dosages ; Emergency Medical Services - methods ; Female ; Humans ; Intensive care ; Intubation ; Intubation, Intratracheal - methods ; Laryngoscopy ; Male ; Middle Aged ; Neuromuscular Depolarizing Agents - administration & dosage ; Paramedics ; Patients ; Success ; Succinylcholine - administration & dosage ; Traumatic brain injury ; Treatment Outcome ; Ventilation ; Victoria</subject><ispartof>Emergency medicine journal : EMJ, 2015-01, Vol.32 (1), p.60-64</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b442t-5b1ceb7459ea32ebd91bb548f6b492bbcf5e73a0cecebc96c68cefd53b4a24963</citedby><cites>FETCH-LOGICAL-b442t-5b1ceb7459ea32ebd91bb548f6b492bbcf5e73a0cecebc96c68cefd53b4a24963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://emj.bmj.com/content/32/1/60.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://emj.bmj.com/content/32/1/60.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24473409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bernard, S A</creatorcontrib><creatorcontrib>Smith, K</creatorcontrib><creatorcontrib>Porter, R</creatorcontrib><creatorcontrib>Jones, C</creatorcontrib><creatorcontrib>Gailey, A</creatorcontrib><creatorcontrib>Cresswell, B</creatorcontrib><creatorcontrib>Cudini, D</creatorcontrib><creatorcontrib>Hill, S</creatorcontrib><creatorcontrib>Moore, B</creatorcontrib><creatorcontrib>St Clair, T</creatorcontrib><title>Paramedic rapid sequence intubation in patients with non-traumatic coma</title><title>Emergency medicine journal : EMJ</title><addtitle>Emerg Med J</addtitle><description>Introduction Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain. Methods The electronic Victorian Ambulance Clinical Information System was searched for the term ‘suxamethonium’ between 2008 and 2011. We reviewed the patient care records and included patients with suspected non-traumatic coma who were treated and transported by road-based paramedics. Demographics, intubation conditions, vital signs (before and after drug administration) and complications were recorded. Younger patients (<60 years) were compared with older patients. Results There were 1152 paramedic RSI attempts of which 551 were for non-traumatic coma. The success rate for intubation was 97.5%. There was a significant drop in blood pressure in younger patients (<60 years) with the mean systolic blood pressure decreasing by 16 mm Hg (95% CI 11 to 21). In older patients, the systolic blood pressure also decreased significantly by 20 mm Hg (95% CI 17 to 24). Four patients suffered brief cardiac arrest during pre-hospital care, all of whom were successfully resuscitated and transported to hospital. Conclusions Paramedic RSI in patients with non-traumatic coma has a high procedural success rate. Further studies are required to determine whether this procedure improves outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Airway management</subject><subject>Allied Health Personnel</subject><subject>Anesthesia</subject><subject>Coma - etiology</subject><subject>Drug dosages</subject><subject>Emergency Medical Services - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intubation</subject><subject>Intubation, Intratracheal - methods</subject><subject>Laryngoscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuromuscular Depolarizing Agents - administration & dosage</subject><subject>Paramedics</subject><subject>Patients</subject><subject>Success</subject><subject>Succinylcholine - administration & dosage</subject><subject>Traumatic brain injury</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Victoria</subject><issn>1472-0205</issn><issn>1472-0213</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqNkE9LwzAYh4Mobk4_gSAFL14687dpjiI6hYEe9ByS9C12rOlMWsRvb0o3D568JD-S5_3x8iB0SfCSEFbcQguhhSqnmLB0UMXwEZoTLmmOKWHHvxmLGTqLcYMxEYqXp2hGOZeMYzVHq1cTTGppXBbMrqmyCJ8DeAdZ4_vBmr7pfIrZLiXwfcy-mv4j853P-2CGNr26zHWtOUcntdlGuNjfC_T--PB2_5SvX1bP93fr3HJO-1xY4sBKLhQYRsFWilgreFkXlitqrasFSGawg4Q5VbiidFBXglluKFcFW6CbqXcXurRo7HXbRAfbrfHQDVGTgkkhWclG9PoPuumG4NN2msgyyeBC0kSxiXKhizFArXehaU341gTr0bPee9ajZz15TlNX--7Bjn-HmYPYBCwnwLabfzX-AO41ieA</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Bernard, S A</creator><creator>Smith, K</creator><creator>Porter, R</creator><creator>Jones, C</creator><creator>Gailey, A</creator><creator>Cresswell, B</creator><creator>Cudini, D</creator><creator>Hill, S</creator><creator>Moore, B</creator><creator>St Clair, T</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20150101</creationdate><title>Paramedic rapid sequence intubation in patients with non-traumatic coma</title><author>Bernard, S A ; Smith, K ; Porter, R ; Jones, C ; Gailey, A ; Cresswell, B ; Cudini, D ; Hill, S ; Moore, B ; St Clair, T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b442t-5b1ceb7459ea32ebd91bb548f6b492bbcf5e73a0cecebc96c68cefd53b4a24963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Airway management</topic><topic>Allied Health Personnel</topic><topic>Anesthesia</topic><topic>Coma - etiology</topic><topic>Drug dosages</topic><topic>Emergency Medical Services - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intubation</topic><topic>Intubation, Intratracheal - methods</topic><topic>Laryngoscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neuromuscular Depolarizing Agents - administration & dosage</topic><topic>Paramedics</topic><topic>Patients</topic><topic>Success</topic><topic>Succinylcholine - administration & dosage</topic><topic>Traumatic brain injury</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><topic>Victoria</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bernard, S A</creatorcontrib><creatorcontrib>Smith, K</creatorcontrib><creatorcontrib>Porter, R</creatorcontrib><creatorcontrib>Jones, C</creatorcontrib><creatorcontrib>Gailey, A</creatorcontrib><creatorcontrib>Cresswell, B</creatorcontrib><creatorcontrib>Cudini, D</creatorcontrib><creatorcontrib>Hill, S</creatorcontrib><creatorcontrib>Moore, B</creatorcontrib><creatorcontrib>St Clair, T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency medicine journal : EMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bernard, S A</au><au>Smith, K</au><au>Porter, R</au><au>Jones, C</au><au>Gailey, A</au><au>Cresswell, B</au><au>Cudini, D</au><au>Hill, S</au><au>Moore, B</au><au>St Clair, T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Paramedic rapid sequence intubation in patients with non-traumatic coma</atitle><jtitle>Emergency medicine journal : EMJ</jtitle><addtitle>Emerg Med J</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>32</volume><issue>1</issue><spage>60</spage><epage>64</epage><pages>60-64</pages><issn>1472-0205</issn><eissn>1472-0213</eissn><abstract>Introduction Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain. Methods The electronic Victorian Ambulance Clinical Information System was searched for the term ‘suxamethonium’ between 2008 and 2011. We reviewed the patient care records and included patients with suspected non-traumatic coma who were treated and transported by road-based paramedics. Demographics, intubation conditions, vital signs (before and after drug administration) and complications were recorded. Younger patients (<60 years) were compared with older patients. Results There were 1152 paramedic RSI attempts of which 551 were for non-traumatic coma. The success rate for intubation was 97.5%. There was a significant drop in blood pressure in younger patients (<60 years) with the mean systolic blood pressure decreasing by 16 mm Hg (95% CI 11 to 21). In older patients, the systolic blood pressure also decreased significantly by 20 mm Hg (95% CI 17 to 24). Four patients suffered brief cardiac arrest during pre-hospital care, all of whom were successfully resuscitated and transported to hospital. Conclusions Paramedic RSI in patients with non-traumatic coma has a high procedural success rate. Further studies are required to determine whether this procedure improves outcomes.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>24473409</pmid><doi>10.1136/emermed-2013-202930</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; BMJ Journals - NESLi2 |
| subjects | Adult Aged Airway management Allied Health Personnel Anesthesia Coma - etiology Drug dosages Emergency Medical Services - methods Female Humans Intensive care Intubation Intubation, Intratracheal - methods Laryngoscopy Male Middle Aged Neuromuscular Depolarizing Agents - administration & dosage Paramedics Patients Success Succinylcholine - administration & dosage Traumatic brain injury Treatment Outcome Ventilation Victoria |
| title | Paramedic rapid sequence intubation in patients with non-traumatic coma |
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