Background
Standard operating procedure and clinical governance
Method
Results
Indications for RSI
|
n
|
%
|
---|---|---|
Actual or impending airway compromise | 42 | 9.7 |
Ventilatory failure | 56 | 12.9 |
Unconsciousness | 271 | 62.6 |
Injured patients who are unmanageable or severely agitated after head injury | 51 | 11.8 |
Anticipated clinical course | 13 | 3.0 |
Humanitarian reasons | 0 | 0.0 |
Summary
|
Trauma
|
Medical
| |||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n: 433 (100%)
|
All trauma
|
Isolated head injury
|
Burns
|
Hanging
|
Other
|
All medical
|
Stroke
|
Intoxication
|
Status epilepticus
|
Ventilatory failure
|
Post - ROSC
|
Other
| |||||||||||||||
65.1%
|
19.1%
|
6.7%
|
2.1%
|
37.2%
|
34.9%
|
8.3%
|
7.2%
|
5.1%
|
4.2%
|
3.2%
|
6.9%
| ||||||||||||||||
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
| ||
Attempts at laryngoscopy
| 1th |
413
|
95.4
|
269
|
95.4
| 80 | 96.4 | 27 | 93.1 | 9 | 100 | 153 | 95.0 |
144
|
95.4
| 36 | 100 | 28 | 90.3 | 21 | 95.5 | 18 | 100 | 12 | 85.7 | 29 | 96.7 |
2th |
15
|
3.5
|
10
|
3.5
| 3 | 3.6 | 1 | 3.4 | 6 | 3.7 |
5
|
3.3
| 2 | 6.5 | 1 | 4.5 | 1 | 7.1 | 1 | 3.3 | |||||||
3th |
1
|
0.2
|
1
|
0.4
| 1 | 0.6 | |||||||||||||||||||||
Failed |
4
|
0.9
|
2
|
0.7
| 1 | 3.4 | 1 | 0.6 |
2
|
1.3
| 1 | 3.2 | 1 | 7.1 | |||||||||||||
Complications
| Hypotension |
35
|
8.1
|
23
|
8.2
| 4 | 4.8 | 3 | 10.3 | 2 | 22.2 | 14 | 8.7 |
12
|
7.9
| 4 | 12.9 | 3 | 13.6 | 4 | 22.2 | 1 | 7.1 | ||||
Desaturation |
35
|
8.1
|
19
|
6.7
| 4 | 4.8 | 1 | 3.4 | 1 | 11.1 | 13 | 8.1 |
16
|
10.6
| 4 | 11.1 | 3 | 13.6 | 2 | 11.1 | 4 | 28.6 | 3 | 10.0 | |||
Aspiration |
5
|
1.2
|
3
|
1.1
| 1 | 1.2 | 1 | 3.4 | 1 | 0.6 |
2
|
1.3
| 2 | 14.3 | |||||||||||||
Bleeding |
5
|
1.2
|
2
|
0.7
| 1 | 1.2 | 1 | 0.6 |
3
|
2.0
| 1 | 3.2 | 2 | 14.3 | |||||||||||||
Misplacement |
3
|
0.7
|
3
|
1.1
| 2 | 2.4 | 1 | 0.6 | |||||||||||||||||||
Hypertension |
3
|
0.7
|
1
|
0.4
| 1 | 1.2 |
2
|
1.3
| 1 | 2.8 | 1 | 3.3 | |||||||||||||||
Dental injury |
2
|
0.5
|
1
|
0.4
| 1 | 0.6 |
1
|
0.7
| 1 | 7.1 | |||||||||||||||||
Bradycardia |
2
|
0.5
|
1
|
0.4
| 1 | 0.6 |
1
|
0.7
| 1 | 4.5 | |||||||||||||||||
On scene time (hh:mm)
| Mean |
0:49
|
0:47
|
0:46
|
0:49
|
0:44
|
0:53
|
0:53
|
0:50
|
0:51
|
0:59
|
0:54
|
0:45
|
0:59
| |||||||||||||
Standard deviation | 0:14 | 0:12 | 0:13 | 0:11 | 0:11 | 0:12 | 0:16 | 0:16 | 0:13 | 0:18 | 0:18 | 0:12 | 0:18 | ||||||||||||||
Minimum | 0:15 | 0:20 | 0:20 | 0:25 | 0:31 | 0:21 | 0:15 | 0:20 | 0:20 | 0:32 | 0:30 | 0:15 | 0:35 | ||||||||||||||
Maximum | 1:50 | 1:32 | 1:32 | 1:17 | 1:01 | 1:31 | 1:50 | 1:21 | 1:23 | 1:50 | 1:23 | 1:04 | 1:49 |
Elements of failed laryngoscopy protocol (30 second drill)
|
n
|
%
|
---|---|---|
Release cricoid pressure | 7 | 1.6 |
Adjust patient position | 9 | 2.1 |
Adjust operator position | 9 | 2.1 |
Suction | 55 | 12.7 |
Backward upward rightward pressure (BURP) | 39 | 9.0 |
Insert blade to maximum and slowly withdraw under vision | 22 | 5.1 |
Change of blade | 9 | 2.1 |
Change of operator | 4 | 0.9 |