[Suggestive guideline for respiratory support in emergency--stepwise breath management]

To propose a guideline of respiratory support for emergency patients.

To summarize the experiences gained in giving stepwise respiratory support (SRS) in 2,548 patients for emergency care (including 1,823 trauma patients and 725 non-trauma patients) between 1992 to 2002.

There were 1,876 male and 672 female patients with the ratio of male to female 2.79:1. The age of patients ranged between 4 to 86 years, and the mean age of traumatic patients was (32.3+/-19.8) years, and the dominant ages were between 20 to 39. The mean age of non-traumatic patients was (65.2+/-17.3) years, and the dominant ages were between 50 to 69. The traumatic and non-traumatic patients accounted for 60.2% and 32.0% of all patients, respectively. The respiratory management included resuscitation positioning in 816 (32.0%), open airway and suctioning in 314 patients (12.3%), oxygenation through nostril or nasal intubation in 2,311 patients (90.7%), oxygenation by mask in 124 patients (4.9%), endotracheal intubation in 254 patients (10.0%), thyrocricocentesis or cricothyrotomy in 25 patients (1.0%), tracheotomy in 195 patients (7.7%), percutaneous tracheotomy in 58 patients (2.3%). SRW management included two types, four steps and ten ways. The two types included traumatic and non-traumatic; the four steps and ten ways included first step of manual treatment (including (1) resuscitation positioning, (2) open airway and suction and (3) chest-back press), second step oxygenation (including (4) oxygenation through nostril or nasal intubation, (5) oxygenation by mask, (6) endotracheal intubation), third step invasive airway support (including (7) thyrocricocentesis or cricothyrotomy and (8) tracheotomy or percutaneous tracheostomy), fourth step mechanic ventilation (covering (9) manual ventilation and (10) mechanical ventilator).

The series of SRS management plan and principles can improve the respiratory support in rescuing emergency patients efficiently.