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Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma

Published online by Cambridge University Press:  24 January 2020

J. Sebastián Espino-Núñez Open the ORCID record for J. Sebastián Espino-Núñez [Opens in a new window] ,
Mirsha Quinto-Sánchez ,
Anabel C. Carrada-Varela  and
Fernando Román-Morales
J. Sebastián Espino-Núñez*
Affiliation:
Tecnológico de Monterrey, School of Medicine, Mexico City, Mexico Department of Anesthesiology, The American British Cowdray Medical Centre IAP, Mexico City, Mexico
Mirsha Quinto-Sánchez
Affiliation:
Forensic Science, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
Anabel C. Carrada-Varela
Affiliation:
Tecnológico de Monterrey, School of Medicine, Mexico City, Mexico
Fernando Román-Morales
Affiliation:
Mexico City’s Health Secretariat, Emergency Medical Regulation Center, Mexico City, Mexico
*
Correspondence: Juan Sebastián Espino-Núñez, EMT, MD Tecnológico de Monterrey Campus Ciudad de México Calle del Puente 222, Ejidos de Huipulco, 14380TlalpanCDMX, Mexico E-mail: sebast.enunez@gmail.com
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Abstract

Introduction:

In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.

Problem:

The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.

Methods:

A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.

Results:

A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.

Conclusions:

Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.

Keywords

brain injurytraumaticdeveloping countriesMexicoprehospital intubationretrospective studies
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 2 , April 2020 , pp. 128 - 132
Copyright
© World Association for Disaster and Emergency Medicine 2020

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