emDocs - July 20, 2020 - By Qasim Z
Originally published at R.E.B.E.L. EM on June 10, 2019
..."Historically there has been concern that by exposing profoundly shocked patients to poorly planned rapid sequence intubation and subsequent positive pressure ventilation, we may incurring more harm than good...
We should strongly consider reordering our approach to resuscitation in the critically ill trauma patient, identifying both overt and covert physiologic threats before proceeding with intubation. When the need for intubation does arise, we need to be optimizing our strategy to ensure both first-pass success and minimal hemodynamic insult...
We need to understand that what we do, despite our best intentions can induce harm if we get it wrong. We should continue to evolve our approach to the physiologically-challenged airway, and that includes the critically injured trauma patient. By paying attention to the order of resuscitation, signs and symptoms of covert shock, and the optimization of our intubation and ventilation strategy, we can minimize any secondary injury to our patients.