2022 SAEM/Simulation Academy Novice Research Grant - $5,000

Rapid sequence intubation (RSI) is one of the most important life-saving procedures in the emergency medicine provider's armamentarium. RSI in the emergency department (ED) setting is often approached in a stepwise, procedural manner with preoxygenation immediately preceding administration of paralytic agents. The patient's abilities to ventilate and oxygenate cease when paralytic agents are administered. As a result, the patient is at risk for a desaturation event, usually considered an Spo2 below 88-92% as this point marks the upper inflection point of the oxygen-hemoglobin desaturation curve. Should there be a prolonged desaturation event, the patient is at risk for organ failure, cardiac arrest, and anoxic brain injury. As a result, it is vital for a provider to monitor the patient's oxygenation status throughout the RSI procedure.

Currently, there are several objective markers available to assess a patient's oxygenation status in real time, and these values can be readily measured and displayed on a patient monitor. Traditionally, the monitor is placed at the head of the patient's bed to allow the medical team to visualize vital signs throughout the course of the medical resuscitation. When an independent provider is required to intubate a patient, they must position themselves at the head of the bed, thus turning his or her back to the patient monitor in a position where it is impossible to visualize directly.

This project seeks to identify if traditional setup may lead to misses or delays in provider recognition of desaturation events and to identify if repositioning of the patient monitor in such a way that provides direct visualization throughout the RSI procedure will lead to a decrease in the number and duration of desaturation events, while alleviating some of the technical difficulty associated with the procedure.