Rapid sequence airway not rapid sequence intubation

Abstract

There has been a focus when managing traumatic brain injury patients on achieving the gold standard of airway management in the field. This has been often quoted as being rapid sequence intubation. This article looks at the evidence to support this notion and attempts to justify consideration to maintaining an adequate airway with the use of a drug assisted (paralysis) supraglottic airway device insertion (intubating laryngeal mask (ILMA). The focus being on adequate ventilation rather than intubation at all costs. Avoidance of hypoxaemia and hypotension, causing secondary brain injury, should be paramount. The article is of relevance to paramedic services considering the introduction of paralysis assisted intubations. In Australia, the remoteness of locations had originally led to upskilling of retrieval paramedics in some regions which has now been transferred to non–rural paramedics. The introduction of paralysis assisted intubation in paramedics has raised the issue of competencies and continuing maintenance of skills programmes. There are, in addition, many training issues and cost implications to maintain paramedic competency in a skill seldom performed. Australia, like many nations, is suffering from an under supply of medical graduates.