Vilke Gary M, Steen Pamela J, Smith Alan M, Chan Theodore C
The Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103, USA.
J Emerg Med. 2002 Jan;22(1):71-4. doi: 10.1016/s0736-4679(01)00439-5.
To evaluate pediatric endotracheal intubations by our paramedics, we performed a retrospective review of a prehospital computer database, quality assurance reviews, and prehospital run sheets for all patients under 15 years of age who had an endotracheal tube (ETT) placed. During the 4.5-year study period, 324 pediatric patients had intubation attempts by field paramedics, of which 264 (82%) were successful and three were reported esophageal and unrecognized by the paramedic. Two of these esophageal placements were noted on arrival at the hospital, and one upon turn-over of patient care to a nurse of an aeromedical service. All three intubations were deemed esophageal with direct laryngoscopy, and the patients had been in cardiopulmonary arrest status prior to the intubation. Of the 264 patients who had ETT placed, 99% were endotracheal, while only 1% were unrecognized esophageal. We conclude that pediatric endotracheal intubation by out-of-hospital paramedics in an established EMS system has a low occurrence of unrecognized esophageal placements.
为评估我们的护理人员进行的儿科气管插管情况，我们对一个院前计算机数据库、质量保证审查以及所有15岁以下放置气管内导管（ETT）患者的院前出诊记录进行了回顾性分析。在4.5年的研究期间，324例儿科患者接受了现场护理人员的插管尝试，其中264例（82%）成功，3例被报告为食管插管且护理人员未识别出来。其中2例食管插管在到达医院时被发现，1例在将患者护理移交给空中医疗服务的护士时被发现。通过直接喉镜检查，所有3例插管均被判定为食管插管，且患者在插管前处于心肺骤停状态。在264例放置了ETT的患者中，99%为气管内插管，而只有1%为未被识别的食管插管。我们得出结论，在既定的紧急医疗服务（EMS）系统中，院外护理人员进行的儿科气管插管未被识别的食管插管发生率较低。
