RAPID-SEQUENCE INTUBATION IN ADULTS WITH ELEVATED INTRACRANIAL-PRESSURE - A SURVEY OF EMERGENCY-MEDICINE RESIDENCY PROGRAMS

A questionnaire entitled ''Survey of Protocols for Rapid Sequence Intu bation in Previously Healthy Adults with Elevated Intracranial Pressur e'' was distributed to the program directors of all 100 emergency medi cine residency programs listed in the Directory of Graduate Medical Ed ucation Programs in February 1995. The medical literature on rapid seq uence intubation in patients with suspected intracranial pressure elev ations was reviewed, The findings of the review were compared with the survey responses. Sixty-seven program directors responded to the surv ey. Sixty five programs performed rapid sequence intubation in their i nstitution. Five programs performed 0 to 10 procedures annually. Six p erformed 10 to 30 annually, 19 performed 30 to 50, 17 performed 50 to 100, and 18 performed more than 100. Succinylcholine and vecuronium we re the most frequently used neuromuscular blockers. Midazolam and thio pental were the most frequently used sedative induction agents. Most p rograms use a defasciculating agent prior to succinylcholine administr ation. The majority of programs do not use a priming agent before the use of a nondepolarizing neuromuscular blocking agent. Intravenous lid ocaine was routinely administered prior to neuromuscular blockade. Fen tanyl was the most frequently used other pretreatment medication. Rapi d sequence intubation is used to facilitate definitive, emergent airwa y management in patients with suspected intracranial pressure elevatio ns in almost all of the emergency medicine residency programs that res ponded to the survey, Most of these programs follow the guidelines rec ommended in the medical literature. The majority of these guidelines, however, are based on statistical data performed in the laboratory or nonemergency environments. Further clinical studies in an emergency me dicine environment must be performed to determine the optimal drug reg imen for rapid sequence intubation in patients with elevated intracran ial pressure. Copyright (C) 1997 by W.B. Saunders Company.