Background: In trauma patients intubated in a physician-led pre-hospital trauma service we prospectively\r\nexamined the rate of misplaced tracheal tubes, the presence and nature of gross airway contamination, and the\r\nvalue of ââ?¬Ë?quick lookââ?¬â?¢ airway assessment to identify patients with subsequent difficult laryngoscopy.\r\nMethods: Patients requiring pre-hospital intubation in a 16 month period were included. Intubation success rate,\r\nmisplaced tracheal tube rate, Cormack and Lehane grade, and the presence and nature of gross airway\r\ncontamination were recorded at laryngoscopy. Tube placement was verified with carbon dioxide detection and\r\nchest x-ray. After visual assessment physicians stated whether laryngoscopy was expected to be a straightforward\r\nor ââ?¬Ë?difficultââ?¬â?¢. The assessment was compared to subsequent laryngoscopy grade.\r\nResults: 400 patients had attempted intubation and 399 were successfully intubated. 42 were in cardiac arrest and\r\nintubated without drugs. There were no oesophageal or misplaced tracheal tubes. Gross airway contamination was\r\nreported in 177 of 400 patients (44%), of which Ã?¾ was from the upper airway. Unconscious patients had higher\r\ncontamination rates (57%) than conscious patients (34%) (p = 0.0001). As a test of difficult intubation, the ââ?¬Ë?quick\r\nlookââ?¬â?¢ generated sensitivity 0.597 and specificity 0.763 (PPV and NPV were 0.336 and 0.904 respectively).\r\nConclusion: This study suggests that when physicians perform pre-hospital anaesthesia they have high intubation\r\nsuccess rates and the use of ETCO2 monitoring reduces or eliminates undetected misplaced tracheal tubes. We\r\nfound high rates of airway contamination; mostly blood from the upper airway. The ââ?¬Ë?quick lookââ?¬â?¢ airway assessment\r\nhad some utility but is unreliable in isolation.
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