Airway intubation in injured patients at the scene of an accident.

Trauma patients requiring intubation at the scene of the accident were entered into a study from June 1985 to June 1987 to determine: 1) the success rate of intubation by flight crews and 2) factors important in managing the difficult airway at the scene. One hundred thirty-six patients were reviewed. The success rate of trauma patients intubated in the field was 92.6%. The success rate of each procedure was, orotracheal 87%, and nasotracheal 77.6%. Six out of the 10 patients unsuccessfully intubated had vomiting or blood in the oropharynx which was cited as the reason for failure of intubation. All 24 patients requiring medications (paralytics and sedatives) for intubation were successfully intubated. Trismus and combativeness were the indications for medication usage. An aeromedical crew (MD, RN, RT) can successfully intubate trauma patients at the scene of the accident. Severe facial injuries with vomiting and blood in the oropharynx are factors in intubation failure. The use of muscle relaxants and sedatives facilitates difficult intubations.