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EtCO2: the key to effective prehospital ventilation
  1. R Owen1,
  2. N Castle2
  1. 1Surrey Ambulance Service NHS Trust, The Horseshoe, Bolters Lane, Banstead, SM7 2AS, UK
  2. 2Durban Institute of Technology, Durban, South Africa
  1. Correspondence to:
 Corresponding author: R Owen
 Surrey Ambulance Service NHS Trust, The Horseshoe, Bolters Lane, Banstead, SM7 2AS, UK; robert.owen{at}

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An advanced life support (ALS) unit staffed by two paramedics and two students was dispatched to a road traffic accident in South Africa. On arrival the team noted an adult male who had fallen from a minibus travelling at speed. The patient was noted to be in extremis:

  • A. Airway was partially obstructed by blood/vomit, although the patient was lying in a lateral position

  • B. Respiration was shallow at 6 breaths min−1 and oxygen saturation via pulse oximetry was 100% on high-flow oxygen

  • C. Heart rate was 100 bpm and blood pressure 160/100 mm Hg

  • D. Eyes – 1; verbal – 1; motor – 3

  • E. Isolated head injury with no other obvious injuries

Treatment priorities where dictated by the need to secure/protect the airway, concerns over hypoventilation,1 and prolonged hospital transfer time. The decision was made to attempt to reduce secondary hypoxic brain injury through endotracheal intubation.2 Due to the presence of trismus, midazolam (5 mg IV) …

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  • Competing interests: none declared