Callahan & Binkley, PLC

Complications Of Prehospital Intubation

  • By: Patrick “Shea” Callahan, Esq.
  • Published: July 17, 2018

When someone suffers a traumatic injury, emergency medical technicians are usually the first people to arrive on the scene. It is important that these technicians proceed with care and precision, especially in high-risk cases. Embodying a light of hope while working under pressure can be hard in the hectic environment that follows an accident.

Endotracheal intubation is a skill that often stands as a means of measuring expertise and ability. During this procedure, a tube in placed into the trachea from the mouth or nose. The mouth is the entry that typically takes place in most emergency situations.

The Purpose Of ETI

In an emergency such as a car accident scene, endotracheal intubation opens the airway to give oxygen. This may support breathing when severe trauma occurs – like a collapsed lung.

Risks Of ETI

The prehospital environment requires unique training. The skill is shaped with unique challenges. EMTs may encounter vomit-flooded airways that require the ability to instantly intubate without assistance. Unlike the controlled environment in the hospital, the ambient lighting in an emergency intubation can cause glare and pupillary constriction for the first responders. This complication requires the responders to know the tricks to fixing this problem, such as placing a coat over one’s head to create a temporary darkness.

Unrecognized or misplaced attempts and post-intubation hypotension are two relatively common complications that tend to trouble prehospital ETIs. A combination of “technology, planning, and sound clinical judgment” may help eliminate misplacement from occurring. Providers must have access to the tools they need for success.

Endotracheal intubation can present a physiologic challenge to unstable patients that may not tolerate the procedure. Postintubation hypotension has been found to be associated with organ dysfunction and, in some cases, death.

Patients in the prehospital setting who require ETI usually have several issues that could lead to sudden cardiovascular collapse. It is important to know that the prehospital setting is a crucial part of saving a patient’s life. The benefit of ETI must always outweigh the risks.

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