A STUDY ON OUTCOME OF INTUBATION IN EMERGENCY DEPARTMENT, HOSPITAL UNIVERSITI SAINS MALAYSIA.
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Date
2011-05
Authors
Rabiha, Mohd Alip
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan Universiti Sains Malaysia
Abstract
Introduction.
In Malaysia, Emergency Medicine is a new specialty without any less
important role in health care delivery. Universiti Sains Malaysia is the first university
in Malaysia offering postgraduate study in Emergency Medicine. Aims of this study
were to observe the outcome of intubations, the success rate of intubations, method of
intubations , presence of difficult airway and complication after intubations in
emergency department, Hospital Universiti Sains Malaysia (HUSM).
Objectives:
To determine the success rate of intubations, method of airway management,
predictors of difficult intubation and complications of intubation performed by airway
personal in emergency department, Hospital Universiti Sains Malaysia (HUSM).
Methodology:
This was a cross sectional observational study done in emergency department,
Hospital Universiti Sains Malaysia (HUSM) in six months. Sample size were 128.
Patients fulfill the inclusion criteria were included in this study. Results were
documented in pre prepared data entry sheet.
Results:
138 patient intubated during this study. Mean age of patient is 50.47 years. Majority
were male , 95(68.84%). 94 case (68.12%) were due to non trauma case and 44
(31.88%) were trauma case. Most frequent indication ware airway at risk with
percentage of 39% . Rapid sequence intubation (RSI) were the most frequent method
of airway management 110 case (79.71%). Fentanyl was the commonest
pretreatment agents used in 65.2% of case. For sedation, 26.6% of non trauma
patients were given midazolam while for trauma, propofol were used. Most common
paralytic agent given were succinylcholine, 72.5%. 98.55% were intubated
successfully and only 2 cases (1.45%) failed intubation. 111 case intubated in single
attempt (80.43%). 6 cases intubated with more then 3 attempts (4.35%). 9 cases
(6.52%) noted to have difficult intubation and most common cause of difficult
intubation were anterior cord position (44.4%). The most frequent intervention for
difficult airway was by using bougie in 4 cases (44.4%). 57 case (43.3%) develop
complication which were hypotension 49.1%, and cardiac arrest 33.3%. 2 factors
showed significant association with successful intubation which were difficult airway
and multiple attempts. Factor associated with difficult intubation were number of
attempts during intubation and the presence of complication.
Conclusion:
Emergency department, Hospital Universiti Sains Malaysia (HUSM) have a very
high success rate of intubation. The most common indications was airway at risk and
common method of intubation done was rapid sequence intubation (RSI). Agent
commonly use for pretreatment were fentanyl, while induction agent used were
propofol and midazolam. For paralytic agent succinylcholine were used in most
intubations. Complication rate were fairly high since due to most cases referred were
severely or critically ill. There were low incidence of difficult intubation. Predictors
of difficult intubations were multiple intubation attempts and development of
complications.
Description
Keywords
Emergency Medicine