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J Korean Soc Emerg Med > Volume 9(4); 1998 > Article
Journal of The Korean Society of Emergency Medicine 1998;9(4): 560-570.
Endotracheal Intubation in Emergency Department
Gil Joon Suh
BACKGROUND: Endotracheal intubation is one of the most important and challenging tasks that an emergency physician has to perform. Complications associated with this procedure range from local trauma of the airway to death caused by unrecognized misplacement of the endotracheal tube. This study was designed to investigate complications of intubation including rapid sequence intubation in the emergency department. METHOD: One hundred four consecutive patients requiring endotracheal intubation in the emergency department of the Stanford Medical Center over a 8-month period were studied prospectively. RESULT: The indications for incubation were acute respiratory failure(60.5%), airway protection(30.8%), and cardiopulmonary arrest(8.7%)). 97(93.3%)intubations were inserted orally, remaining 7(6.7%) were intubated via the nasotracheal route. Of 97 orotacheal intubations, sapid sequence incubation was used in 71(73.2%) cases. Grouped by level of training, junior residents attempted 69(66.3%) intubations, senior residents 21(20.2%), and star 13(12.5%). Of the 104 intubations, 92(88.5%) were successful on the flit or second attempt. 12 procedures(11.5%) required more than two attempts at intubation. A total of 36(34.6%) complications occurred. Esophageal incubations occurred in 13 cases, right main stem intubation in 13, pulmonary aspiration in 4, and others in 6. Fourteen patients(13.5%) died after intubation.
The complication rate of endotracheal intubation in the emergency department is high. In order to decrease the complication, detailed knowledge, skill, and equipments about endotracheal incubation are required. The good condition of a patient before incubation appears to be important far survival.
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