ENDOTRACHEAL INTUBATION IN EMERGENCY- AN EXPERIENCE FROM EASTERN NEPAL.

Corresponding Author:
Dr. Rabin Bhandari,
Additional Professor,
Department of General Practice and Emergency Medicine,
B. P. Koirala Institute of Health Sciences,
Dharan, Nepal.
E-mail: rabin.bhandari@bpkihs.edu

ABSTRACT

BACKGROUND

Emergency Medical Care in Nepal is gradually improving with an increase in dedicated emergency departments with skilled manpower and availability of equipment, mostly in medical colleges and secondary to tertiary care centres.

MATERIALS AND METHODS

We conducted a cross-sectional descriptive study in a Medical University in the Eastern part of Nepal to find out the intubation success rates and the current practice/ method used to perform emergency intubations in our emergency.

RESULTS

215 intubated patients, median age 43 years with a male-to-female ratio of 1.26 were studied. Indications to intubate were failure to ventilate (53.0%), airway protection (36.7%) and expectant airway management including need for transport (10.2%). The intubating doctors had experience of less than 6 months in 47 (21.86%, 95% CI 16.53 - 27.99), more than 6 months in 151 (70.23%, 95% CI 63.64 - 76.26) and senior operators in 17 (7.91%, 95 CI 4.67 - 12.36) patients for 1st attempt intubations. Method used was rapid sequence intubation in 27 patients (12.56%, 95% CI 8.44 - 17.74), partial (sedation only) in 128 patients (59.52%, 95% CI 52.65 - 66.16) and crash intubation (no drugs) in 60 patients (27.91%, 95% CI 22.02 - 34.41). Urgent cases had more chances of intubation without use of any drugs (p < 0.001). Midazolam was the drug used most frequently. Suxamethonium was the only muscle relaxant used. Intubation was successful at first attempt in 164 patients (76.28%, 95% CI 70.02 - 81.80), second attempt in 33 patients (15.35%, 95% CI 10.81 - 20.87) and third attempt in 18 patients (8.37%, 95% CI 5.04 - 12.91). More experienced doctors had a better chance for success in the 1^st attempt (n= 215, p= 0.003, Fisher’s exact test). Second attempt (30/33) and third attempt intubation (17/18) were undertaken by seniors. Oesophageal intubation was recorded in 27 cases and immediate haemodynamic instability in 4 cases.

CONCLUSION

Majority of intubations are performed by emergency doctors with success and acceptable complication rates. The proportion of patients undergoing intubation only under sedation is high.

Keywords

Emergency, Endotracheal Intubation, Nepal.