identified five factors associated with ETI failure: trismus, inability to pass the tube through the cords, inability to visualize the cords, presence of gag reflex, and increased weight. Although the need for DAI is infrequent in most EMS systems, having it available to adequately skilled and trained providers can save lives.ĭAI provides the most optimal intubating conditions. In general, aeromedical EMS providers have been shown to have higher success rates with DAI. Paramedics with more extensive training and experience have been shown to have higher DAI success rates. DAI can be seen as an expansion of skills that paramedics and other advanced prehospital providers already possess. Many prehospital providers already perform ETI as part of their scope of practice. Īddition of a critical life-saving tool to the prehospital provider’s armamentarium. For non-arrest patients, drug-facilitated intubation and RSI have been associated with increased ETI success rates. All of the indications for ETI in the emergency department are relevant to the prehospital setting. Having DAI available in these situations could be life-saving. Situations in which DAI may be indicated include respiratory distress, decreased level of consciousness, intoxication, traumatic injury, and noncompliance with noninvasive ventilation attempts. In brief, indications for emergency ETI include:Īirway and ventilatory control in patients with intact airway reflexes. Although nasotracheal intubation is possible, it has largely fallen out of favor in the urgent care setting. In general, ETI refers to the placement of an endotracheal tube orally. The use of DAI by emergency medical services (EMS) systems varies throughout the United States. Some studies indicate that RSI is more successful than intubation with sedation alone both in the prehospital setting and the emergency department. RSI is the most common type of prehospital DAI performed. ETI without the use of neuromuscular blockade is known as sedation-facilitated or medication-facilitated ETI. ETI with the use of neuromuscular blockade is known as rapid-sequence intubation (RSI). Drug-assisted intubation (DAI) is a term used for any use of medications to facilitate endotracheal intubation (ETI), with or without neuromuscular blocking agents. The prehospital provider must be skilled in various methods of airway support ranging from simple airway positioning to the establishment of a definitive airway with an endotracheal tube. Airway control is a critical skill for the prehospital healthcare provider.
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