[Rapid sequence intubation (RSI) in a patient with severe head injury on the island--a case report and review of the literature]

Abstract

A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) as a modification of endotracheal intubation (EI) has been recognized as a core procedure within the domain of emergency physician. The technique is termed rapid sequence because it involves simultaneous induction of sedation and neuromuscular blockade, usually with succinylcholine. The method is very successfully used by trained non-anesthesiologists, physicians and ambulance paramedics in western countries, when traumatized patients are agitated and combative, uncooperative, hypoxic, hemodinamically unstable or have an increased risk of aspiration. EI is more difficult to perform in these patients and it can additionally aggravate their condition. A case is presented of a 21-year-old man with traumatic head injury and agitation on the island of Korcula, in whom RSI was succesfully performed to facilitate intubation. The standard protocol of RSI is shown where pharmacologic adjuncts to intubation are applied after the neccesery preparation. Some specific problems in the emergency care of severely injured patients on the island of Korcula are pointed out, suggesting the need to improve the education of physicians working in emergency medicine with the introduction of specialization in emergency medicine. It is an imperative to proceed with the implementation of recent programs with the purpose of emergency medical service improvement in the country, especially on distant islands.