Comparison of Rapid Sequence Intubation Protocol Versus Conventional Intubation at the Emergency Department in Songklanagarind Hospital: A Pilot Study.

Objective: To compare the success rates, complication rates and intubation time between the diagnostic-based Rapid Sequence Intubation (RSI) protocol and conventional intubation without muscle relaxants.Materials and methods: This comparative prospective observational study was conducted at the Emergency Department in Songklanagarind Hospital from 1 April, 2008 to 30 November, 2008. Patients included were those over 18 years old who needed endotracheal intubation at the Emergency Department. The data was divided into 2 groups on consecutive periods; the pre-protocol (conventional) and post-protocol (RSI) groups. The patient’s information included sex, age, vital signs, indication for intubation, intubators, complications, intubation time and drugs used.Results: There were 45 patients; 38 patients in the conventional group and 7 patients in the RSI group. The overall success rate (intubation in term of ≤ 2 attempts) was 88.9%, without statistically significant between the groups regarding success rate and intubation time (p-value=1.000 and 0.088 respectively). The complication rate in the conventional group was significantly higher than in the RSI group (p-value= 0.047).Conclusions: This pilot study showed that the RSI had the same success rate and intubation time with the conventional intubation with fewer complications. 

Canadian triage and acuity scale in the Emergency Department

 Objectives: To determine the relationship between expense and waiting time with using Canadian Triage and Acuity Scale (CTAS) level, to evaluate the validity of the CTAS triage that was implemented in Emergency Department (ED)Materials and methods: This was a prospective observational study conducted between April 1st and July 6th, 2008. Patients who were triaged by emergency medicine residents at our institution using CTAS (level I-V) were included in the study. The correlations between CTAS levels with waiting times and hospital expense of the patient was calculated.Results: Seven hundred and eighty nine patients were enrolled. The median expenses associated with each CTAS level were CTAS level I 2,576 Baht, CTAS level II 745 Baht, CTAS level III 155 Baht, CTAS level IV 124 Baht and CTAS level V 80 Baht. The median waiting times were CTAS level I 9 minutes, CTAS level II 12 minutes, CTAS level III 18 minutes, CTAS level IV 32 minutes and CTAS level V 42 minutes. For both variables, the differences between groups were statistically significant as determined by the Kruskal-Wallis test in both variables.Conclusion: CTAS is significantly related to the cost of treatment and the waiting time in patients who visited the ED.