Objectives

The objectives of this chapter are to:

• understand the principles of patient management following successful intubation

• understand the principles of monitoring, ongoing sedation and neuromuscular blockade for intubated patients

• be familiar with the correct operation of transport ventilators

• be familiar with the principles of patient preparation for safe transfer.

Introduction

After a successful rapid sequence induction (RSI) has been performed there is often an understandable sense of relief that the airway has been secured. However, intubation is only the initial phase of management; the post-intubation phase is equally important.

Following emergency airway management, most patients will need transfer to other areas such as the radiology department, intensive care unit (ICU), operating theatres or tertiary care in another hospital. The key questions are:

• What is the predicted clinical course?

• Is the patient stable enough to transfer?

• Is any further treatment required?

The objectives of the post-intubation phase are to achieve enough physiological stability for transfer, and to carry out other appropriate treatment.

The requirements for stabilization and the nature of treatment may vary considerably: for example, a patient intubated for overdose can often be stabilized and treated while waiting for an ICU bed. A patient with a suspected traumatic extradural haemorrhage should undergo CT scanning as soon as adequate physiological stability is achieved. An unstable multi-trauma patient may need urgent transfer to the operating room to achieve surgical haemorrhage control.

This phase can be described using a modified ABCDE system. The sections below form a checklist.