INTUBATION DIFFICULTY IN POISONED PATIENTS - ASSOCIATION WITH INITIALGLASGOW-COMA-SCALE SCORE

Objective: To determine whether the initial Glasgow Coma Scale (GCS) s core is predictive of intubation difficulty in out-of-hospital airway management of poisoned patients. Methods: A prospective, observational study was performed in a toxicological intensive care unit of a unive rsity hospital and in a physician-based out-of-hospital care system. S ubjects included consecutive poisoned patients intubated during their airway management by out-of-hospital medical teams before hospitalizat ion. The intubating operator (emergency physician or nurse anesthetist ) completed a I-page checklist concerning the clinical parameters and circumstances (nature of sedation and difficulty) of endotracheal intu bation upon hospital arrival. Results: Forms were completed for all 39 4 consecutive out-of-hospital intubations. The patients ranged from 15 to 95 years of age (median age 38 years). Most (96%) of the intubatio ns were via the oral route. Intubation difficulty was related to GCS v alues. Intubation difficulty was seen more often in patients with 7 le ss than or equal to GCS less than or equal to 19 (36%) than in patient s with GCS <7 (15%) or >9 (10%). Not surprisingly, perceived intubatio n difficulty was least for those patients undergoing rapid-sequence in tubation rather than administration of sedation alone. Conclusion: Max imum difficulty of intubation is encountered in poisoned patients with 7 less than or equal to GCS less than or equal to 9. Intubation of su ch patients appears to be facilitated by appropriate sedation and/or n euromuscular blockade.