Emergency intubation for paralysis of the uncooperative trauma patient

• Published in: The Journal of emergency medicine Vol. 9; no. 1; pp. 9 - 12
• Main Authors: Kuchinski, Joseph, Tinkoff, Glen, Rhodes, Michael, Becher, John W.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 1991; Elsevier
• Subjects: Adult; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical Protocols - standards; Cost-Benefit Analysis; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Evaluation Studies as Topic; Hospitalization - economics; Humans; Intensive care medicine; intubation; Intubation, Intratracheal - methods; Intubation, Intratracheal - standards; Length of Stay - statistics & numerical data; Medical sciences; Multiple Trauma - classification; Multiple Trauma - complications; Multiple Trauma - therapy; Neuromuscular Nondepolarizing Agents - administration & dosage; Neuromuscular Nondepolarizing Agents - therapeutic use; Outcome and Process Assessment (Health Care); paralysis; Psychomotor Agitation - complications; Psychomotor Agitation - drug therapy; Psychomotor Agitation - economics; restraint; resuscitation; Retrospective Studies; Severity of Illness Index; trauma; trauma; resuscitation; intubation; paralysis; restraint; Human; Agitation; Intubation; Emergency; Trachea; Trauma; Resuscitation
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/0736-4679(91)90524-J

The impact of paralysis followed by intubation was studied in patients who had been traumatized and subsequently admitted to Lehigh Valley Hospital Center. Trauma admission records between January 1987 and June 1988 were reviewed. Fifty-seven patients, intubated for control of agitation and combativeness, were divided into high injury severity (HIS) and low injury severity (LIS) subgroups using admission trauma (TS) and injury severity scores (ISS). Thirty-eight (70%) were classified as HIS and 19 (30%) as LIS. All HIS patients had significant injuries diagnosed following paralysis with intubation (PWI). Mortality in the HIS group was 9%. The LIS subgroup was compared to a randomly selected group of similarly injured blunt trauma patients who did not require PWI. There were significant differences ( P < 0.05) in age, hospital cost, hours per day of nursing care, and percent of patients with an ETON level > 100 mg%. Emergency paralysis with intubation is an effective method for controlling the uncooperative, combative, seriously injured patient. However, patients with low injury severity who require restraint have higher costs and require more care if they are paralyzed and intubated than if they are not.