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  • The haemodynamic response to pre-hospital RSI in injured patients

    Author(s)
    Perkins, ZB
    Gunning, M
    Crilly, J
    Lockey, D
    O'Brien, B
    Griffith University Author(s)
    Crilly, Julia
    Year published
    2013
    Metadata
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    Abstract
    BACKGROUND: Laryngoscopy and tracheal intubation provoke a marked sympathetic response, potentially harmful in patients with cerebral or cardiovascular pathology or haemorrhage. Standard pre-hospital rapid sequence induction of anaesthesia (RSI) does not incorporate agents that attenuate this response. It is not known if a clinically significant response occurs following pre-hospital RSI or what proportion of injured patients requiring the intervention are potentially at risk in this setting. METHODS: We performed a retrospective analysis of 115 consecutive pre-hospital RSI's performed on trauma patients in a physician-led ...
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    BACKGROUND: Laryngoscopy and tracheal intubation provoke a marked sympathetic response, potentially harmful in patients with cerebral or cardiovascular pathology or haemorrhage. Standard pre-hospital rapid sequence induction of anaesthesia (RSI) does not incorporate agents that attenuate this response. It is not known if a clinically significant response occurs following pre-hospital RSI or what proportion of injured patients requiring the intervention are potentially at risk in this setting. METHODS: We performed a retrospective analysis of 115 consecutive pre-hospital RSI's performed on trauma patients in a physician-led Helicopter Emergency Medical Service. Primary outcome was the acute haemodynamic response to the procedure. A clinically significant response was defined as a greater than 20% change from baseline recordings during laryngoscopy and intubation. RESULTS: Laryngoscopy and intubation provoked a hypertensive response in 79% of cases. Almost one-in-ten patients experienced a greater than 100% increase in mean arterial pressure (MAP) and/or systolic blood pressure (SBP). The mean (95% CI) increase in SBP was 41(31-51) mmHg and MAP was 30(23-37) mmHg. Conditions leaving the patient vulnerable to secondary injury from a hypertensive response were common. CONCLUSIONS: Laryngoscopy and tracheal intubation, following a standard pre-hospital RSI, commonly induced a clinically significant hypertensive response in the trauma patients studied. We believe that, although this technique is effective in securing the pre-hospital trauma airway, it is poor at attenuating adverse physiological effects that may be detrimental in this patient group.
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    Journal Title
    Injury
    Volume
    44
    Issue
    4
    DOI
    https://doi.org/10.1016/j.injury.2012.03.019
    Subject
    Clinical sciences
    Nursing
    Nursing not elsewhere classified
    Publication URI
    http://hdl.handle.net/10072/55990
    Collection
    • Journal articles

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