C Donald1, R Duncan, S Thakore. 1. Emergency Department, Ninewells Hospital, Dundee DD1 9SY, UK. colindonald@nhs.net
Abstract
AIM: In patients presenting to the emergency department (ED) with significant poisoning and reduced Glasgow coma score (GCS), the decision to proceed with rapid sequence intubation can be a difficult one. Traditionally, patients with a GCS of 8 or less are thought to require airway protection. It has been found that a number of these patients can be managed safely without advanced airway support in a well-monitored ward environment. The objective of this study was to define the key physiological indicators of intubation requirement in this complex group of patients. METHOD: Prospective parallel group comparison. The study was conducted in the ED of a Scottish teaching hospital over a 12-month period. Group 1 included all poisoned patients admitted to the ED with a GCS of 8 or less who were not intubated and managed conservatively in the short-stay ward. Group 2 included all poisoned patients with a reduced GCS who were intubated. Demographics and physiological parameters were analysed in both groups (intubated vs non-intubated). RESULTS: 12 patients were identified in the intubated group and 14 in the non-intubated group. Demographics were similar in both groups. Analyses of means and medians of physiological parameters indicated minimal predominance of oxygenation/ventilatory failure in the group requiring intubation. This correlated with the physician's perception of inadequate airway protection or ventilatory failure. CONCLUSION: Clinical assessment by experienced medical staff rather than physiological variables are the key to determining intubation requirements in the poisoned patient with reduced GCS. GCS alone is not a good predictor of intubation.
AIM: In patients presenting to the emergency department (ED) with significant poisoning and reduced Glasgow coma score (GCS), the decision to proceed with rapid sequence intubation can be a difficult one. Traditionally, patients with a GCS of 8 or less are thought to require airway protection. It has been found that a number of these patients can be managed safely without advanced airway support in a well-monitored ward environment. The objective of this study was to define the key physiological indicators of intubation requirement in this complex group of patients. METHOD: Prospective parallel group comparison. The study was conducted in the ED of a Scottish teaching hospital over a 12-month period. Group 1 included all poisoned patients admitted to the ED with a GCS of 8 or less who were not intubated and managed conservatively in the short-stay ward. Group 2 included all poisoned patients with a reduced GCS who were intubated. Demographics and physiological parameters were analysed in both groups (intubated vs non-intubated). RESULTS: 12 patients were identified in the intubated group and 14 in the non-intubated group. Demographics were similar in both groups. Analyses of means and medians of physiological parameters indicated minimal predominance of oxygenation/ventilatory failure in the group requiring intubation. This correlated with the physician's perception of inadequate airway protection or ventilatory failure. CONCLUSION: Clinical assessment by experienced medical staff rather than physiological variables are the key to determining intubation requirements in the poisoned patient with reduced GCS. GCS alone is not a good predictor of intubation.