Paper Example on Analysis of Prehospital Rapid Sequence Intubation in Emergency Service South Africa

Introduction

Rapid Sequence intubation (RSI) has been considered by several health facilities in South Africa to improve the success of end tracheal intubation (ETI) in specific Pre-hospital settings (Lewis et al., 2018). However, there is insufficient literature to prove the RSI is effective in the given settings (Thompson et al., 2020). The essay sought to establish if trauma patients intubated by RSI in South Africa in Prehospital settings receive adequate survival compared to those who have not undergone RSI.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

What is Rapid Sequence Intubation?

Rapid sequence intubation (RSI) refers to an airway management technique that produces induction agents. This technique is considered an effective one in a control emergency airway (Tran et al., 2017). This procedure is usually applied when there is no time, or the luxury of effectively pepping the patient with their airway or breathing is compromised (Okubo et al., 2017). The spectrum behind RSI is that the patient is sedated and paralyzed to allow intubation without applying artificial breaths through a bag valve mask. This is aimed at preventing insufflation of the patient's stomach and the danger of aspiration from vomiting. RSI has a considerable list of mnemonics to help health caregivers adequately prepare for successful intubations in severe incidents (Okubo et al., 2017). The health caregiver must ensure that the preparation procedures are nicely channeled for a successful intubation process for patients in Prehospital settings.

Benefits Associated with RSI?

RSI, an advanced airway management system, has many benefits that have allowed healthcare practitioners to use the procedure that was once being applied in operating rooms only (Merelman et al., 2019). RSI benefits include improved oxygenation and ventilation for patients with compromised breathing (Olvera, and Daniel, 2020). The procedure also enhances aspiration protection as well as the protection of the decompensating airway. Again, it helps in spinal protection via sedation and paralysis (Raineri et al., 2017). The procedure can also decrease compromised endotracheal intubations in some scenarios (Kramer et al., 2018). RSI can also help in the penetration of the endotracheal tube via the vocal cords.

The risks associated with RSI?

Even though RSI has many benefits, there are also many known risks associated with this procedure. First, since human beings perform it, the individual experience of clinicians could vary. This is deemed to put patients at various risks. Hypoxia is a common risk resulting from a lack of preoxygenation or successive penetration of the tube. RSI can also contribute to the lethal triad of acidosis and coagulopathy (Thompson et al., 2020). RSI is also associated with Prehospital anesthesia that is linked to hypothermia, which harms trauma patients. RSI is also associated with hyperventilation which could further decrease venous return (Thompson et al., 2020). There are also risks of fixation errors during the whole process. Generally, since the RSI procedure depends on individual clinicians' experience, patients are exposed to wide-ranged risks.

Implementation of RSI in South Africa and the challenges of RSI in South Africa

The Professional Board for Emergency Care, which forms the Health Professions Council of South Africa, permitted RSI application and has been part of registered emergency care practitioners (Stein et al., 2011). Despite the widespread use of RSI in South Africa and the various registered benefits, there are several challenges in applying the procedure in the country. The Prehospital may not be implemented in all emergency medical services in South Africa (Stassen et al., 2018). This primary reason is a lack of resources. For the adequate implementation of RSI, there is a need to conduct training, afford systems requirements, and fair clinic governance. However, South Africa has not been in a position to meet these requirements fully.

Reference List

Stein, C., Botha, M., Kramer, E., Nevin, D., Dickerson, R., Goldstein, L., Wells, M., Muhlberger, D., and Vincent-Lambert, C., 2011. Prehospital rapid sequence intubation. SAMJ South African Medical Journal, 101(3), pp.163-164. Retrieved from: https://go.gale.com/ps/i.do?id=GALE%7CA252553777&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=02569574&p=HRCA&sw=w

Stassen, W., Lithgow, A., Wylie, C., and Stein, C., 2018. A descriptive analysis of endotracheal intubation in a South African Helicopter Emergency Medical Service. African Journal of Emergency Medicine, 8(4), pp.140-144. Retrieved from: https://www.sciencedirect.com/science/article/pii/S2211419X18300132

Lewis, C.T., Brown, J., Inglis, A.C., Naumann, D.N., and Crombie, N., 2018. Emergency intubation in trauma in KwaZulu-Natal Province, South Africa. South African Medical Journal, 108(8). Retrieved from: https://www.ajol.info/index.php/samj/article/view/178616

Thompson, P., Hudson, A.J., Convertino, V.A., Bjerkvig, C., Eliassen, H.S., Eastridge, B.J., Irvine-Smith, T., Braverman, M.A., Hellander, S., Jenkins, D.H. and Rappold, J.F., 2020. Risk of Harm Associated With Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32969011/

Merelman, A.H., Perlmutter, M.C., and Strayer, R.J., 2019. Alternatives to rapid sequence intubation: contemporary airway management with ketamine. Western Journal of Emergency Medicine, 20(3), p.466. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526883/

Olvera, D., and Daniel, D., 2020. The benefits of positive pressure ventilation for preoxygenation before rapid sequence intubation are dependent upon oxygenation status. British Journal of Anaesthesia, 125(1), p.e203. Retrieved from: https://www.bjanaesthesia.org.uk/article/S0007-0912(20)30242-7/pdf

Kramer, N., Lebowitz, D., Walsh, M., and Ganti, L., 2018. Rapid sequence intubation in traumatic brain-injured adults. Cureus, 10(4). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017125/

Raineri, S.M., Cortegiani, A., Accurso, G., Procaccianti, C., Vitale, F., Caruso, S., Giarratano, A., and Gregoretti, C., 2017. Efficacy and safety of using high-flow nasal oxygenation in patients undergoing rapid sequence intubation. Turkish Journal of Anaesthesiology and Reanimation, 45(6), p.335. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772412/

Tran, D.T.T., Newton, E.K., Mount, V.A.H., Lee, J.S., Mansour, C., Wells, G.A., and Perry, J.J., 2017. Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review. Anaesthesia, 72(6), pp.765-777. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/anae.13903

Okubo, M., Gibo, K., Hagiwara, Y., Nakayama, Y., Hasegawa, K., and Japanese Emergency Medicine Network Investigators, 2017. The effectiveness of rapid sequence intubation (RSI) versus non-RSI in the emergency department is an analysis of the multicenter prospective observational study. International Journal of Emergency Medicine, 10(1), p.1. Retrieved from: https://link.springer.com/article/10.1186/s12245-017-0129-8