Misplaced endotracheal tubes by paramedics in an urban emergency medical services system

摘要: Abstract Study Objective: To determine the incidence of unrecognized, misplaced endotracheal tubes inserted by paramedics in a large urban, decentralized emergency medical services (EMS) system. Methods: We conducted prospective, observational study patients intubated field before department arrival. During an 8-month period, physicians assessed tube position at ED arrival using combination auscultation, end-tidal carbon dioxide (ETCO 2 ) monitoring, and direct laryngoscopy. Results: A total 108 were studied. On ED, 25% (27/108) found to have improperly placed tubes. Of tubes, 67% (18/27) be esophagus, whereas 33% (9/27), tip was hypopharynx, above vocal cords. with noted (3/9) died while ED. For 56% (5/9) had evidence ETCO on esophageal placement arrival, (10/18) Esophageal intubation associated absence expired CO (17/18, 94%) The singe patient this subset recordable been nasotracheally esophagus spontaneous respirations present. 63% (68/108) laryngoscopy addition determination. All evaluation performed whom demonstrated underwent In cases which not performed, attending physician documented conjunction presence bilateral breath sounds. Conclusion: out-of-hospital, our community is excessively high may reflective occurring other communities. Data from communities are needed clarify scope alarming issue. [Katz SH, Falk JL. Misplaced urban Ann Emerg Med. January 2001;37:32-37.]