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Wed 0915 Pulse oximetry during helicopter transport
WED 0900
WED 0915
IMPACT OF THE USE OF PARALYZING AGENTS IN AIRWAY MANAGEMENT OF TRAUMA SYSTEM PATIENTS IN THE FIELD
PULSE OXIMETRY DURING HELICOPTER TRANSPORT R. DeJarnette, R. Holleran, N. Peter, C. Downing, J. Wilhite, D. Storer University of Cincinnati Air Care 234 Goodman St., Cincinnati, Ohio 45267 INTRODUCTION: The purpose of our study was to determine the accuracy/reliability of pulse oximetry when used during helicopter transport. METHODS: Data was gathered on I01 patients over the age of 18 years transported by helicopter. Each patient's oximeter reading of oxygen saturation and heart rate were documented. Vital signs and flight team interventions were recorded. Patients returning to the Emergency Department had blood gases drawn, if indicated, and the arterial saturations recorded. The oximeter used was a Criticare 503 model with either a hard probe or a disposable tape probe. Any problems with the oximeter were recorded. Statistical procedures used include: PHI Coefficient, Paired t-test, Univariate Repeated Measures with Greenhouse-Geisser Epsilon P-value adjustment. RESULTS: i) The pulse oximeter was mechanically reliable 89% of the time. 2) There was no correlation between the probe type and the documented failures of the oximeter (PHI - 0.009). 3) 02 saturation readings obtained by the pulse oximeter were compared to the patient's arterial blood gas. No significant difference was found (t=1.344, p=0.185) 4) The patients palpated pulse and the heart rate sensed by the pulse oximeter were also compared. No significant differance was found (t-0.806, p=0.424). 5) The percent saturation and the heart rate readings proved to be consistent throughout flight, (p=0.168, p=0.86 respectively). CONCLUSION: The vibration and other environmental conditions of helicopter transport had no significant effect on the accuracy of the pulse oximeter percent saturation readings. Both probes performed equally well. The pulse oximeter is a valuable adjunct in the care of ill or injured patients transported by air. This study was funded in part by a grant from the Foundation of Air Medical Research. Oximeters were provided by Criticare Systems Inc.
William Long, Sue Shidner, John Zelko, Life Flight Personnel; Trauma Services/Life Flight, Emanuel Hospital & Health Center, 2801 N. Gantenbein, Portland, Oregon 97227. On scene intubation of the severly injured trauma patient may be difficult because of patient's combative behavior, clenched teeth, bloody secretions, oromaxillofacial trauma. An audit of intubation success rates in trauma system patients by prehospital care providers in the Portland Metropolitan area showed 50% intubation success for EMT's and 62% for Life Flight (LF) personnel. LF implemented an intensive operating room training program to develop skills and experience with intubation with neuromuscular blocking agents (NMBA) on elective surgery patients. Following a six month training period (9/89-2/90), we approved and implemented a protocol for field intubation with NMBA of trauma patients aged six or older. We compared intubation success rates preNMBA training with post-training and trauma patient scene times before and after training. From 3/90-8/81 (the post-training period), LF attempted intubation on 108 trauma system patients and intubated successfully 95 (88%), a 22% success rate improvement (P < 0.05). 84 trauma system patients (78%) received NMBA with intubation, 75 (89%) of which LF intubated successfully. Increasing LF experience with NMBA showed a 95% success rate for the last six months, 9/91-8/91, as compared to 83% for the first six months, 3/90-8/90, (P < 0.05). Intubation with NMBA increased average scene times significantly over pre-NMBA study period, 19.7 minutes vs. 13.7 minutes (P < 0.05). Excluding unusual circumstances for prolonged scene calls, pre-training average scene times were 11.4 minutes vs. post-training 16.7 minutes (P < 0.05). Average scene times posttraining decreased significantly with experience from the six months, 19.5 minutes, to the last six months, 15.4 minutes (P < 0.05). There were ten complications associated with field intubations during the study period. One posterior pharyngeal tear, four mainstem bronchial intubations, and five induced emesis. NMBA and training facilitate intubation and improve success rates, but prolong scene times.
The Journal of Air Medical Transport • October 1992
69
WED 0915
IMPACT OF THE USE OF PARALYZING AGENTS IN AIRWAY MANAGEMENT OF TRAUMA SYSTEM PATIENTS IN THE FIELD
PULSE OXIMETRY DURING HELICOPTER TRANSPORT R. DeJarnette, R. Holleran, N. Peter, C. Downing, J. Wilhite, D. Storer University of Cincinnati Air Care 234 Goodman St., Cincinnati, Ohio 45267 INTRODUCTION: The purpose of our study was to determine the accuracy/reliability of pulse oximetry when used during helicopter transport. METHODS: Data was gathered on I01 patients over the age of 18 years transported by helicopter. Each patient's oximeter reading of oxygen saturation and heart rate were documented. Vital signs and flight team interventions were recorded. Patients returning to the Emergency Department had blood gases drawn, if indicated, and the arterial saturations recorded. The oximeter used was a Criticare 503 model with either a hard probe or a disposable tape probe. Any problems with the oximeter were recorded. Statistical procedures used include: PHI Coefficient, Paired t-test, Univariate Repeated Measures with Greenhouse-Geisser Epsilon P-value adjustment. RESULTS: i) The pulse oximeter was mechanically reliable 89% of the time. 2) There was no correlation between the probe type and the documented failures of the oximeter (PHI - 0.009). 3) 02 saturation readings obtained by the pulse oximeter were compared to the patient's arterial blood gas. No significant difference was found (t=1.344, p=0.185) 4) The patients palpated pulse and the heart rate sensed by the pulse oximeter were also compared. No significant differance was found (t-0.806, p=0.424). 5) The percent saturation and the heart rate readings proved to be consistent throughout flight, (p=0.168, p=0.86 respectively). CONCLUSION: The vibration and other environmental conditions of helicopter transport had no significant effect on the accuracy of the pulse oximeter percent saturation readings. Both probes performed equally well. The pulse oximeter is a valuable adjunct in the care of ill or injured patients transported by air. This study was funded in part by a grant from the Foundation of Air Medical Research. Oximeters were provided by Criticare Systems Inc.
William Long, Sue Shidner, John Zelko, Life Flight Personnel; Trauma Services/Life Flight, Emanuel Hospital & Health Center, 2801 N. Gantenbein, Portland, Oregon 97227. On scene intubation of the severly injured trauma patient may be difficult because of patient's combative behavior, clenched teeth, bloody secretions, oromaxillofacial trauma. An audit of intubation success rates in trauma system patients by prehospital care providers in the Portland Metropolitan area showed 50% intubation success for EMT's and 62% for Life Flight (LF) personnel. LF implemented an intensive operating room training program to develop skills and experience with intubation with neuromuscular blocking agents (NMBA) on elective surgery patients. Following a six month training period (9/89-2/90), we approved and implemented a protocol for field intubation with NMBA of trauma patients aged six or older. We compared intubation success rates preNMBA training with post-training and trauma patient scene times before and after training. From 3/90-8/81 (the post-training period), LF attempted intubation on 108 trauma system patients and intubated successfully 95 (88%), a 22% success rate improvement (P < 0.05). 84 trauma system patients (78%) received NMBA with intubation, 75 (89%) of which LF intubated successfully. Increasing LF experience with NMBA showed a 95% success rate for the last six months, 9/91-8/91, as compared to 83% for the first six months, 3/90-8/90, (P < 0.05). Intubation with NMBA increased average scene times significantly over pre-NMBA study period, 19.7 minutes vs. 13.7 minutes (P < 0.05). Excluding unusual circumstances for prolonged scene calls, pre-training average scene times were 11.4 minutes vs. post-training 16.7 minutes (P < 0.05). Average scene times posttraining decreased significantly with experience from the six months, 19.5 minutes, to the last six months, 15.4 minutes (P < 0.05). There were ten complications associated with field intubations during the study period. One posterior pharyngeal tear, four mainstem bronchial intubations, and five induced emesis. NMBA and training facilitate intubation and improve success rates, but prolong scene times.
The Journal of Air Medical Transport • October 1992
69