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Basic airway management

Ajay P Nayak, Tonio Pera, Deepak A Deshpande, James V Michael, Jennifer R Liberato, Shi Pan, Eric Tompkins, Henry P Morelli, Roslyn Yi, Nadan Wang, Raymond B Penn
Ovarian cancer G protein-coupled receptor 1 (OGR1) is a recently deorphanized G protein-coupled receptor shown to signal in response to low extracellular pH (↓pHo) or certain benzodiazepines. The pleiotropic nature of OGR1 signaling in human airway smooth muscle (HASM) cells suggests OGR1 is a potential therapeutic target for the management of obstructive lung diseases. However, the basic pharmacological and regulatory features of OGR1 remain poorly understood. We employed model systems of heterologously-expressed (HEK293 cells) or endogenous (HASM) OGR1 to assess changes in expression, subcellular localization, and signaling capabilities following acute or chronic treatment with ↓pHo or the benzodiazepines lorazepam and sulazepam...
February 6, 2019: American Journal of Physiology. Lung Cellular and Molecular Physiology
Kelly M Dean, Christine E DeMason, Sukgi S Choi, Kelly M Malloy, Sonya Malekzadeh
OBJECTIVES: Simulation-based boot camps have gained popularity over the past few years, with some surgical specialties implementing mandatory national boot camps. However, there is no consensus in otolaryngology on boot camp timing, learner level, or curriculum. The purpose of this study is to examine the current landscape and gather opinions regarding future curriculum and standardization of boot camps in otolaryngology. METHODS: A survey was developed to examine current resident participation and boot camp content while also seeking opinions regarding improving boot camp enrollment and standardizing curriculum...
January 28, 2019: Laryngoscope
Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari, Hans Morten Lossius
BACKGROUND: Effective and timely airway management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and advanced airway management remains controversial but there are a proportion of critically ill and injured patients who require urgent advanced airway management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and advanced airway management. METHOD: This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts...
January 21, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Sidhartha R Ramlatchan, Nicholas Kramer, Latha Ganti
The authors report a case of a 69-year-old female with difficulty swallowing and neck swelling and review the clinical presentation, radiographic features and treatment of adult epiglottitis. Epiglottitis remains a medical emergency, with the potential for airway compromise. The authors present this case because it is a potentially life-threatening infection that warrants prompt diagnosis and management. This case is worth reporting because epiglottis in adults can have a milder and less classic presentation that sometimes results in delayed recognition...
October 22, 2018: Curēus
Elena-Laura Lemaitre, Laurent Tritsch, Eric Noll, Pierre Diemunsch, Nicolas Meyer
AIM OF THE STUDY: The role of supraglottic devices in airway management in out-of-hospital cardiac arrest (OHCA) remains controversial. The aim of this study was to evaluate the feasibility and effectiveness of intubation through the Intubating Laryngeal Mask Airway (ILMA) when used by prehospital emergency nurses in the setting of OHCA. METHODS: We conducted a prospective, observational trial during 12 years by the Fire Department and prehospital emergency service of the health district of Strasbourg, France...
December 17, 2018: Resuscitation
Dan Bieler, Anna Hörster, Rolf Lefering, Axel Franke, Christian Waydhas, Stefan Huber-Wagner, Markus Baacke, Thomas Paffrath, Jan Wnent, Ruth Volland, Barbara Jakisch, Felix Walcher, Martin Kulla
BACKGROUND: The TraumaRegister DGU® (TR-DGU) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) enables the participating hospitals to perform quality management. For that purpose, nine so-called audit filters have existed, since its foundation, which, inter alia, is listed in the Annual Report. The objective of this study effort is a revision of these quality indicators with the aim of developing pertinent new and reliable quality indicators for the management of severely injured patients...
December 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Nathan Smischney, Rahul Kashyap, Mohamed Seisa, Darrell Schroeder, Daniel Diedrich
BACKGROUND: Endotracheal intubation can occur in up to 60% of critically ill patients. Despite the frequency with which endotracheal intubation occurs, the current practice is largely unknown. This is relevant, as advances in airway equipment (ie, video laryngoscopes) have become more prevalent, leading to possible improvement of care delivered during this process. In addition to new devices, a greater emphasis on airway plans and choices in sedation have evolved, although the influence on patient morbidity and mortality is largely unknown...
December 7, 2018: JMIR Research Protocols
Elias Baedorf Kassis, Stephen H Loring, Daniel Talmor
Ventilator management of patients with acute respiratory distress syndrome (ARDS) has been characterized by implementation of basic physiology principles by minimizing harmful distending pressures and preventing lung derecruitment. Such strategies have led to significant improvements in outcomes. Positive end expiratory pressure (PEEP) is an important part of a lung protective strategy but there is no standardized method to set PEEP level. With widely varying types of lung injury, body habitus and pulmonary mechanics, the use of esophageal manometry has become important for personalization and optimization of mechanical ventilation in patients with ARDS...
October 2018: Annals of Translational Medicine
Michelle Tsao, Angelica A Vargas, John Hajduk, Renee Singh, Narasimhan Jagannathan
Structural and physiologic differences between a pediatric and an adult patient can make management of the pediatric airway a challenge. The majority of initial designs for airway devices were modeled for adult patients and simply downsized for the pediatric population. This paper reviews the last decade's design improvements in video laryngoscopes and supraglottic airway devices, as well as advances in the development of non-invasive oxygenation/ventilation techniques for pediatric airway management. Areas covered: Topic areas reviewed include basic principles of common and newer devices for video laryngoscopy, supraglottic airway management, and alternate ventilation techniques...
November 19, 2018: Expert Review of Medical Devices
Piyush Mehta, C Bothiraja, Kakasaheb Mahadik, Shivajirao Kadam, Atmaram Pawar
Pulmonary disease represents a major global health issue. They are commonly treated by various synthetic molecules. But, frequent high-dose of oral and injectable drugs may lead to severe side effects and this juncture demands inhaled formulations that facilitate effective drug delivery to the lower airways with negligible side effects. Natural phytoconstituents or phytoalexin (i.e. plant antibiotics) have showed an unique treatment array with minimum side effects and great capability to treat intrapulmonary and extrapulmonary diseases compared to synthetic drugs...
December 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Alison Matthews
Airway management in the wilderness runs the gamut from basic airway support to endotracheal intubation. Fortunately, direct laryngoscopy is a seldom called upon skill in expedition medicine. However, the medical skills required during a mission or expedition are never truly known in advance. Improvisation during evolving medical events is a mainstay of expedition medicine education and practice. It is unlikely, given constraints of weight and size of expedition medical kits, that a conventional laryngoscope would find its way into a standard "go bag...
September 2018: Wilderness & Environmental Medicine
Samuel A Tisherman, Deborah M Stein
OBJECTIVES: To describe the current state of the art regarding management of the critically ill trauma patient with an emphasis on initial management in the ICU. DATA SOURCES AND STUDY SELECTION: A PubMed literature review was performed for relevant articles in English related to the management of adult humans with severe trauma. Specific topics included airway management, hemorrhagic shock, resuscitation, and specific injuries to the chest, abdomen, brain, and spinal cord...
December 2018: Critical Care Medicine
Asbjørn Hasselager, Doris Østergaard, Tim Kristensen, Claus Sønderskov, Cathrine Bohnstedt, Torsten L B Lauritsen, Lars Konge, Martin G Tolsgaard
BACKGROUND: Standardised courses for laypeople in Paediatric Basic Life Support (PBLS) and Foreign Body Airway Obstruction Management (FBAOM) teach essential skills for the initiation of resuscitation by bystanders. Performance assessments are necessary to ensure that skills are acquired. We aimed to examine the validity of developed performance assessments and to determine credible pass/fail standards. METHODS: Validity evidence was gathered in a standardised simulated setting by testing participants with three different levels of PBLS/FBAOM experience: untrained laypersons, trained laypersons, and lifeguards...
September 6, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Martyn F Biddiscombe, Omar S Usmani
Inhaled medication is the cornerstone in the treatment of patients across a spectrum of respiratory diseases including asthma and chronic obstructive pulmonary disease. The benefits of inhaled therapy have long been recognised but the most important innovations have occurred over the past 60 years, beginning with the invention of the pressurised metered dose inhaler. However, despite over 230 different device and drug combinations currently being available, disease control is far from perfect. Here we look at how innovation in inhaler design may improve treatments for respiratory diseases and how new formulations may lead to treatments for diseases beyond the lungs...
September 2018: Breathe
H Ilper, C Franz-Jäger, C Byhahn, M Klages, H H Ackermann, K Zacharowski, T Kunz
In 1985 Mallampati et al. published a non-invasive score for the evaluation of airways (Mallampati grading scale, MGS), which originally consisted of only three different classes and has been modified several times. At present it is mostly used in the version of Samsoon and Young consisting of four different classes. Class I: soft palate, fauces, uvula, palatopharyngeal arch visible, class II: soft palate, fauces, uvula visible, class III: soft palate, base of the uvula visible and class IV: soft palate not visible...
October 2018: Der Anaesthesist
Riaz Aziz, Soledad Colombe, Gibonce Mwakisambwe, Solomon Ndezi, Jim Todd, Samuel Kalluvya, Halinder S Mangat, Reed Magleby, Arndt Koebler, Bernard Kenemo, Robert N Peck, Jennifer A Downs
BACKGROUND: Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]...
August 2018: PLoS Neglected Tropical Diseases
Louis Gonzales, Brandon K Oyler, Jeff L Hayes, Mark E Escott, Jose G Cabanas, Paul R Hinchey, Lawrence H Brown
OBJECTIVE: To compare OHCA outcomes in patients managed with mechanical versus manual CPR in an EMS system with a "pit crew" approach to resuscitation and a scripted sequence for the initiation of mechanical CPR. METHODS: Through a year-long quality improvement effort we standardized the initial resuscitative efforts for OHCA, prioritizing a "pit crew" approach to high quality manual CPR, early defibrillation and basic airway management ahead of a scripted sequence for initiating mechanical CPR...
August 11, 2018: American Journal of Emergency Medicine
Neil Coleman, Tomas Barry, Helen Tobin, Niall Conroy, Gerard Bury
BACKGROUND: Paediatric airway management is of fundamental importance in the critically unwell child. Pre-hospital paediatric airway management especially endotracheal intubation is however controversial. AIM: To explore Irish Advanced Paramedics (APs) training, experience and clinical practice in paediatric airway management as well as to examine clinician attitudes toward this topic. METHODS: An anonymous online survey of all graduates of the University College Dublin AP training program (N = 453)...
August 15, 2018: Irish Journal of Medical Science
Christopher Newell, Scott Grier, Jasmeet Soar
After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Michael W van Emden, Jeroen J Geurts, Patrick Schober, Lothar A Schwarte
BACKGROUND: Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemask ventilation, tracheal intubation, and laryngeal mask insertion compared to a manikin (SimMan 3G) and formalin-fixed cadavers. METHODS: Thirty anesthesiologists and experienced residents ("operators") were instructed to perform the 3 airway techniques in 10 F4L, 10 formalin-fixed cadavers, and 1 manikin...
October 2018: Anesthesia and Analgesia
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