Rapid sequence intubation in the Emergency Department: Is cricoid pressure nothing more than a pain in the neck?

INTERVENTION: A force of 30‐40N is applied to the patient's cricoid during intubation. This is achieved by the cricoid operator standing on a platform scale and reducing their weight on the scales by 3.060 ‐ 4.075 kg while applying pressure to the patient's cricoid. A data recorder records weight data for later analysis by the researchers. Once successful intubation is confirmed by end‐tidal CO2, aspirates will be suctioned from the oropharynx and trachea. the aspirates will be tested for the presence of pepsin. The patient's records will be reviewd at 28 days to determine whether they were treated for aspiration pneumonitis. CONDITION: Cricoid pressure and aspiration in emergency intubations. PRIMARY OUTCOME: Aspiration rate determined by the presence of pepsin in the trachea and/or if the patient is treated for aspiration pneumonia up to 28 days post‐intubation. SECONDARY OUTCOME: Ease of intubation, determined by: the number of attempts required to place ETT, prolonged intubation (>10 mins.) using conventional laryngosopy or a required change in operator. Grade of laryngoscopic view obtained using the Modified system (1, 2a, 2b, 3 or 4). Incidence of failed intubation (termination of the attempt at rapid sequence inutbation, use of laryngeal mask or surgical airway). INCLUSION CRITERIA: All adult patients presenting to the Emergency Department requiring intubation.