Field airway management of the trauma patient: the efficacy of bag mask ventilation.

There is no consensus on what constitutes appropriate field airway management in the seriously injured semiconscious patient. The respiratory complications in a selected group of patients who were transported from the scene of an accident by a helicopter service whose policy was to perform endotracheal intubation on only deeply obtunded patients and manage others with bag mask ventilation are reported. Respiratory compromise was defined as follows: partial pressure of oxygen less than 65 torr on initial hospital arterial blood gases, partial pressure of carbon dioxide greater than 45 torr on initial hospital arterial blood gases, or radiographic and clinical evidence of aspiration pneumonitis within 5 days of admission to the hospital. From a total of 116 patients transported from the scene of an accident during the period of this investigation, there were 42 patients with Trauma Scores between 4 and 14 whose records were studied in detail. Ten of these patients ha adequate perfusion and abnormal arterial blood gases after arrival at the receiving hospital. Five patients might have benefited from endotracheal intubation in the field, but there were no preventable deaths. Neurologic status of the patient appeared to be more useful than respiratory status in predicting respiratory compromise.