Basic airway management

Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.

OBJECTIVE: The shock index (SI), the ratio of heart rate to systolic blood pressure, is a clinical tool for assessing injury severity. Age-adjusted SI models may improve predictive value for injured children in the out-of-hospital setting. We sought to characterize the proportion of children in the prehospital setting with an abnormal SI using established criteria, describe the age-based distribution of SI among injured children, and determine prehospital interventions by SI. METHODS: We performed a multi-agency retrospective cross-sectional study of children (<18 years) in the prehospital setting with a scene encounter for suspected trauma and transported to the hospital between 2018 and 2022 using the National Emergency Medical Services (EMS) Information System datasets...

BACKGROUND: The standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical care centres in China. OBJECTIVE: To establish expert consensus on the essential capability lists for neonatal critical care at three levels in China. DESIGN AND SETTING: According to China's administrative divisions, the Chinese guidelines stratifies neonatal critical care into three levels: county level (basic and special care), city level (intensive care) and province level (comprehensive care including neonatal surgery and more subspecialty interventions)...

BACKGROUND: Effects of Dictamnus dasycarpus Turcz. on allergic asthma and their underlying mechanisms remain unclarified. Thus, we investigated the effects of D. dasycarpus Turcz. water extract (DDW) on mucus hypersecretion in mice with ovalbumin (OVA)-induced asthma and human bronchial epithelial cells. METHODS: BALB/c mice were used to establish an OVA-induced allergic asthma model. Mice were grouped into the OVA sensitization/challenge, 100 and 300 mg/kg DDW treatment, and dexamethasone groups...

There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios...

INTRODUCTION: It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. METHODS: This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea...

INTRODUCTION: A 4-week summer preceptorship offered first-year medical students early exposure to anesthesiology following their preclerkship courses in pharmacology and cardiopulmonary physiology. The main objective was to provide students with clinical skills and prepare them for rotations while immersing them in a unique experience, introducing a specialty not covered in core rotations. METHODS: Participants were selected via their responses to an application...

The methacholine challenge test (MCT) is a standard evaluation method of assessing airway hyperresponsiveness (AHR) and its severity, and has significant clinical value in the diagnosis and treatment of bronchial asthma. A consensus working group consisting of experts from the Pulmonary Function and Clinical Respiratory Physiology Committee of the Chinese Association of Chest Physicians, the Task Force for Pulmonary Function of the Chinese Thoracic Society, and the Pulmonary Function Group of Respiratory Branch of the Chinese Geriatric Society jointly developed this consensus...

BACKGROUND: Emergent airway occurrences pose a significant threat to patient life. Extracorporeal membrane oxygenation (ECMO) has been proven to be an effective method for managing emergent airways. METHODS: A retrospective analysis was conducted on all patients receiving ECMO as an adjunct for emergent airway management from January 2018 to December 2022 at the People's Hospital of Zhongshan City. We collected the basic information of the patients, their blood gas data before and after ECMO, the related parameters of ECMO, and the outcome and then analyzed and summarized these data...

INTRODUCTION AND OBJECTIVE: The oropharyngeal airway, also known as the Guedel airway, is a crucial medical device used for over a century as a basic way to maintain a patient's airway open and secure. Although it is easy to use, this can be misleading as incorrect sizing can lead to injuries, bleeding, laryngospasm, and potentially fatal complications. This study aims to compare three techniques for selecting the appropriate oropharyngeal airway size using craniofacial anatomical landmarks...

Sedation for invasive procedures is given for various clinical purposes to patients of all ages worldwide. However, sedation is a continuum to general anesthesia and contains severe inherent risks leading to mortality. Providing a simulation-based sedation training course (SEDTC) to various medical staff could be an effective strategy to improve patient and medical safety associated with sedation. The SEDTC generally includes basic airway management such as upper airway obstruction release or rapid response action toward excessive sedation, utilizing problem-based learning or simulators...

Ultrasound evaluation of the upper airway has emerged as an essential instrument for clinicians, offering real-time assessment that can help to guide interventions and improve patient outcomes. This review aims to provide health care providers with a practical approach to performing ultrasound evaluation of the upper airway, covering basic physics relevant to upper airway ultrasound, the identification of key anatomical structures, and elucidating its various clinical applications, such as prediction of difficult airway, confirmation of endotracheal intubation, and guidance for surgical airway procedures and airway blocks...

PURPOSE: First- and second-year medical students typically have limited exposure to the field of anesthesiology, yet recent match data shows growing interest in the specialty. Early, structured exposure to anesthesiology in the form of a preclinical elective may allow medical students to make more informed decisions on their specialty of choice. METHODS: The anesthesiology preclinical elective, BIOL 6704: "Anesthesia: Much More than Putting you to Sleep", is a one-credit course taught at The Warren Alpert Medical School of Brown University...

OBJECTIVE: This study investigates the effects of tracheal stenosis on distal airway pressure during low-frequency jet ventilation (LFJV) in tracheal stenosis resection procedures, focusing on variables like stenosis size, depth, scope type, and inlet pressure. METHODS: A 3D-printed human airway model was employed, featuring inserted tracheal stenoses of varied sizes and depths. Distal airway pressure was measured with 16 pressure transducers, and data were processed via MATLAB...

The incidence of chronic airway diseases in China has been increasing every year, resulting in a high burden of disease. Inhalation therapy is widely used as a basic first-line treatment for such diseases. However, inappropriate selection of inhalation devices and usage methods is common, leading to poor disease control and prognosis, as well as a waste of medical resources. In order to facilitate the reasonable selection and appropriate use of inhaler devices, improve the efficacy of inhalation therapy, and increase patient compliance, the Inhalation Therapy and Respiratory Rehabilitation Group, Respiratory Equipment Committee of China Association of Medical Equipment, and Chinese Chronic Obstructive Pulmonary Disease Coalition organized experts to revise the Chinese expert consensus on standardized inhaler device application in stable chronic respiratory disease patients (2019 Edition) based on the latest evidence-based medical evidence and clinical diagnosis and treatment experience...

Survival benefits of prehospital advanced airway and epinephrine in out-of-hospital cardiac arrest (OHCA) patients are controversial, but few studies evaluated this together. This study evaluated association of prehospital advanced airway and epinephrine with survival outcomes in OHCA patients. This was observational study using a prospective multicentre KoCARC registry. Adult OHCA patients between October 2015 and December 2021 were included. The variables of interest were prehospital managements, which was classified into basic life support (BLS)-only, BLS + advanced airway, and BLS + advanced airway + epinephrine...

Objective: The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric fistulas in open abdomen treatment. Methods: In this retrospective observational study, we collected data on 214 patients with open abdomen complicated by entero-atmospheric fistulas admitted to Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School from January 2012 to January 2021. We collected their basic characteristics, aetiology, treatment plan, and prognosis, including the durations of hospitalization and open treatment, time to resumption of enteral nutrition, duration and prognosis of definitive surgery, and overall prognosis...

BACKGROUND: The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana...

In specific clinical scenarios, fiberoptic intubation (FOI) may be the preferred technique for airway management and endotracheal intubation. In addition to topical anesthesia of the airway, sedation is frequently necessary, especially in younger patients, to facilitate the procedure. The goal is to facilitate the procedure by providing sedation, anxiolysis, and analgesia with maintenance of spontaneous ventilation. Remimazolam is a novel benzodiazepine with a short half-life and limited context sensitive half-life that can be titrated by continuous infusion...

BACKGROUND: Long term care (LTC) services for functionally impaired senior citizens are crucial for addressing the challenges of aging. However, research on eligibility criteria and coverage of LTC in China is lacking. Our objective is to assess the current status of LTC and explore eligibility criteria and coverage for the elderly. METHODS: This is a cross-sectional study conducted in two first-tier cities in China. Residents aged 65 or over were recruited from a nursing home and four primary hospitals...