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Video analysis of Emergency Medicine residents performing rapid-sequence intubations1

Presented at the Society of Academic Emergency Medicine annual meeting, Chicago, Illinois, May 1998.
https://doi.org/10.1016/S0736-4679(00)00168-2Get rights and content

Abstract

The purpose of this study was to evaluate Emergency Medicine resident physicians’ compliance with our institution’s rapid sequence intubation (RSI) protocol by the use of videotape analysis. We conducted a prospective, observational study of Emergency Medicine resident physicians (EM 1,2,3) as they were videotaped performing RSI on medical and trauma patients. The videotapes were reviewed by the study investigators to assess the rates of deviation from our standard RSI protocol. Forty-four RSIs performed by 33 residents were studied. The most common deviations from our standard RSI protocol concerned proper use of the Sellick maneuver (45%) and use of the end-tidal CO2 detector (34%). Videotape analysis provides an objective measure of Emergency Medicine resident performance of RSI.

Introduction

Patients presenting to the Emergency Department (ED) fre- quently need emergent intubation. Many of these are done by the rapid-sequence intubation (RSI) technique. This allows for rapid airway management while minimizing the risk of aspiration 1, 2. The protocol for RSI is well-defined and widely accepted throughout the Emergency Medicine literature 1, 2, 3, 4, 5. Walls described this protocol, which includes the five “P’s”: preparation, preoxygenation, pretreatment, paralyzing the patient, and passing the tube 1, 2, 5.

RSI is a skill that Emergency Medicine resident physicians must master during their training program. The specific skills are generally learned through “hands-on” experience while working in the ED or operating room. Evaluation of skills comes primarily from informal feedback by attending physicians after the procedure. This feedback, however, is relatively subjective and based on recollection of events that occur rapidly. Without proper feedback and correction of mistakes, improper habits may escape detection and become entrenched. Videotaping resident physicians performing RSI may provide a more objective measure of their skills. The primary purpose of this study was to evaluate resident physicians’ performance of RSI compared with our institution’s standard RSI protocol by the use of videotape analysis. A secondary purpose of the study was to compare residents’ actual performance of RSI on videotape with their immediate recall of their performance after the procedure.

Section snippets

Materials and methods

An observational prospective study using a convenience sample was conducted at a suburban, level 1 trauma, 600-bed teaching hospital. The resident physicians involved in the study signed a consent form beforehand allowing the videotaping, and they were aware of the purpose of the study. Consent for review of the videotape was obtained after the procedure from family members of the patients intubated. If consent was refused or the family members were unavailable, the videotape was immediately

Results

Forty-four RSIs performed by 33 residents (14 EM-1, 8 EM-2, 11 EM-3) were studied from July 1996−June 1998. The percentage of deviations for specific steps (Table 2 ) include: Sellick maneuver from paralysis until confirmation of tube placement (45%), end-tidal CO2 detector use (34%), pulse oximetry check postintubation (14%), pretreatment dose of a nondepolarizing paralytic agent (11%), appropriate preoxygenation (9%), pulse oximetry placed preintubation (9%), suction set-up (7%), endotracheal

Discussion

RSI is a skill that Emergency Medicine resident physicians must master. Traditionally, this is performed in the ED or the operating room under the direct supervision of an attending physician. Feedback regarding performance comes primarily from informal discussion after the procedure. This feedback, however, is subjective and based upon recollection of events that occur rapidly, with important details possibly being overlooked. Videotaping the procedure and providing feedback based upon review

References (15)

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1

Education is coordinated by Stephen R. Hayden, MD, of the University of California San Diego Medical Center, San Diego, California

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