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RSI Intubation

Urs Pietsch, Giacomo Strapazzon, Dimitri Ambühl, Volker Lischke, Simon Rauch, Jürgen Knapp
BACKGROUND: Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC. METHODS: We retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Kathleen Berg, Victoria Gregg, Peter Cosgrove, Matthew Wilkinson
BACKGROUND: The administration of postintubation sedation (PIS) is an essential component of postintubation care. Recent studies in the adult emergency medicine literature have highlighted both delays in time to administration of PIS and subtherapeutic dosing of sedative agents in the emergency department. We aimed to investigate the administration of PIS in the pediatric population as this has not been adequately reviewed to date. OBJECTIVES: The aim of this study was to determine the percentage of pediatric emergency department patients who received PIS within an adequate time frame...
January 29, 2019: Pediatric Emergency Care
Michael St Pierre, Frederick Krischke, Bjoern Luetcke, Joachim Schmidt
BACKGROUND: Aspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants' airway management. METHODS: Eighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study...
January 24, 2019: BMC Anesthesiology
Christophe Guitton, Stephan Ehrmann, Christelle Volteau, Gwenhael Colin, Adel Maamar, Vanessa Jean-Michel, Pierre-Joachim Mahe, Mickael Landais, Noelle Brule, Cedric Bretonnière, Olivier Zambon, Mickael Vourc'h
PURPOSE: Preoxygenation with high-flow therapy by nasal cannulae (HFNC) is now widespread in the intensive care unit (ICU). However, no large randomized study has assessed its relevance in non-severely hypoxemic patients. In a randomized controlled trial (PROTRACH study), we aimed to evaluate preoxygenation with HFNC vs. standard bag-valve mask oxygenation (SMO) in non-severely hypoxemic patients during rapid sequence intubation (RSI) in the ICU. METHODS: Randomized controlled trial including non-severely hypoxemic patients requiring intubation in the ICU...
January 21, 2019: Intensive Care Medicine
Kamal Kajal, Amarjyoti Hazarika, Seran Reddy, Kajal Jain, Shyam Charan Meena
Context: Although international guidelines have been developed for emergency tracheal intubation (ETI), there is little evidence of their applicability in developing countries. Aims: The aim of this study was done to evaluate the different methods of ETI that are practiced among anesthetist and anesthesia trainees in India outside operating room (OR)/intensive care unit (ICU) settings. Settings and Design: This was prospective observational audit did among anesthesia personals managing ETI outside OR and ICU...
October 2018: Anesthesia, Essays and Researches
Wenxi Tang, Penghui Wei, Jiapeng Huang, Na Zhang, Haipeng Zhou, Jinfeng Zhou, Qiang Zheng, Jianjun Li, Zhigang Wang
BACKGROUND: The asleep-awake-asleep (AAA) technique and laryngeal mask airway (LMA) is a common general anesthesia technique for deep brain stimulation (DBS) surgery. However, the LMA is not always the ideal artificial airway. In this report, we presented our experiences with nasotracheal intubation-extubation-intubation (IEI) and AAA techniques in DBS surgery for Parkinson's disease (PD) patients to meet the needs of surgery and ensure patients' safety and comfort. CASE PRESENTATION: Three PD patients scheduled for DBS surgery had to receive general anesthesia for various reasons...
January 17, 2019: BMC Anesthesiology
Alexandra E Cesare, Lorenzo C Rafer, Conrad S Myler, Kristin B Brennan
BACKGROUND Ehlers-Danlos syndrome, hypermobility type is characterized by increased extensibility, permeability, and fragility of the affected cartilaginous tissues, including the trachea, larynx, and skin. Anesthetic considerations for patients with this syndrome include intubation difficulties secondary to the collapse of fibro-elastic tissues in the trachea and a reported resistance to local anesthetics. CASE REPORT Our patient was a 22-year-old G4P0030 woman with a history of morbid obesity, seizures, Barrett's esophagus, hypermobility being evaluated for Ehlers-Danlos syndrome, and anaphylaxis to an unknown local anesthetic who was scheduled for cesarean delivery...
January 10, 2019: American Journal of Case Reports
Bianca M Wahlen, Ayman El-Menyar, Mohammad Asim, Hassan Al-Thani
BACKGROUND: We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction (RSI) among trauma patients. METHODS: A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating specialties...
2019: World Journal of Emergency Medicine
E Ter Avest, J Griggs, C Prentice, J Jeyanathan, R M Lyon
INTRODUCTION: Helicopter emergency medical services (HEMS) are often dispatched to patients in traumatic cardiac arrest (TCA) as they can provide treatments and advanced interventions in the pre-hospital environment that have the potential to contribute to an increased survival. This study, aimed to investigate the added value of HEMS in the treatment of TCA. METHODS: We performed a retrospective cohort study of all patients with a pre-hospital TCA who were attended by a non-urban HEMS (Kent, Surrey and Sussex Air Ambulance trust) between July 1st 2013 and May 1st 2018...
December 28, 2018: Resuscitation
E Ter Avest, J Griggs, C Prentice, J Jeyanathan, R M Lyon
INTRODUCTION: Helicopter emergency medical services (HEMS) are often dispatched to patients in traumatic cardiac arrest (TCA) as they can provide treatments and advanced interventions in the pre-hospital environment that have the potential to contribute to an increased survival. This study, aimed to investigate the added value of HEMS in the treatment of TCA. METHODS: We performed a retrospective cohort study of all patients with a pre-hospital TCA who were attended by a non-urban HEMS (Kent, Surrey and Sussex Air Ambulance trust) between July 1st 2013 and May 1st 2018...
December 28, 2018: Resuscitation
Kevin M Overmann, Stephanie D Boyd, Yin Zhang, Benjamin T Kerrey
BACKGROUND: Apneic oxygenation is the delivery of oxygen to the nasopharynx during intubation. It may mitigate the risk of oxyhemoglobin desaturation but has not been well-studied in children. METHODS: We conducted a retrospective, observational study of patients undergoing rapid sequence intubation (RSI) in a pediatric emergency department. We compared patients who received apneic oxygenation, delivered via simple nasal cannula at age-specific flow rates, to patients who did not receive apneic oxygenation...
October 18, 2018: American Journal of Emergency Medicine
Aurélie Birenbaum, David Hajage, Sabine Roche, Alexandre Ntouba, Mathilde Eurin, Philippe Cuvillon, Aurélien Rohn, Vincent Compere, Dan Benhamou, Matthieu Biais, Remi Menut, Sabiha Benachi, François Lenfant, Bruno Riou
Importance: The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial. Objective: To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed. Design, Setting, and Participants: Randomized, double-blind, noninferiority trial conducted in 10 academic centers. Patients undergoing anesthesia with RSI were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge (last follow-up, February 8, 2017)...
October 17, 2018: JAMA Surgery
Scott K Dietrich, Mark A Mixon, Ryan J Rogoszewski, Stephanie D Delgado, Vanessa E Knapp, Michael Floren, Julie A Dunn
Present guidelines for emergency intubation in traumatically injured patients recommend rapid sequence intubation (RSI) as the preferred method of airway management but specific pharmacologic agents for RSI remain controversial. To evaluate hemodynamic differences between propofol and other induction agents when used for RSI in trauma patients. Single-center, retrospective review of trauma patients intubated in the emergency department. Patients were divided in two groups based on induction agent, propofol or nonpropofol...
September 1, 2018: American Surgeon
Nesrin Ahu Aslan, Çağıl Vural, Ali Abbas Yılmaz, Zekeriyya Alanoğlu
Objective: We investigated the effects of four different anaesthesia induction protocols on the haemodynamic response to laryngoscopy and tracheal intubation during rapid-sequence induction (RSI) in systolic hypertensive patients. Methods: One hundred and twenty hypertensive adult patients (systolic pressure >140 mmHg and diastolic pressure <90 mmHg), classified according to the American Association of Anesthesiologists as Class II and III were randomized into four groups...
September 2018: Turkish Journal of Anaesthesiology and Reanimation
Walker Pride, Alexander Smith, Ryan Joseph
Thyroid storm is a rare complication with an estimated incidence ranging from 0.61 to 0.76 cases per 100,000 people. Common causes include intrinsic hyperthyroidism, such as in Grave's disease, infection, surgery, severe emotional stress, and acute trauma to the thyroid gland. Without immediate treatment, mortality is seen in up to 30% of cases. Here, we report a case of a 46-year-old male who presented with a possible food impaction for the past 48 h. The patient developed extreme hypertension, tachycardia, and diaphoresis immediately following rapid sequence intubation (RSI), which, after further work-up, was due to thyroid storm...
December 2018: American Journal of Emergency Medicine
Jochen Hinkelbein, Peter Kranke
A Rapid Sequence Induction and Intubation (RSI oder RSII) is a standard technique for emergency airway management and anaesthesia. The aim of an RSI is to prevent aspiration by fast endotracheal intubation without the use of facemask ventilation.Today, only few European countries have specific guidelines for RSI. During daily practice, head-up positioning is standard and provides some advantages as compared to other positions. A gastric tube should be left in place; it is not necessary to remove it. If no gastric tube is in place, it can be positioned after intubation...
September 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
F F Girrbach, F Hilbig, M Michael, M Bernhard
BACKGROUND: A myriad of publications have contributed to an evidence-based approach to airway management in emergency services and admissions in recent years; however, it remains unclear which international registries on airway management in emergency medicine currently exist and how they are characterized concerning inclusion criteria, patient characteristics and definition of complications. METHODS: A systematic literature research was carried out in PubMed with respect to publications from 2007-2017...
September 2018: Der Anaesthesist
Tony L Smith, Jessica Van Meter
Within emergency care settings, rapid sequence intubation (RSI) is frequently used to secure a definitive airway (i.e., endotracheal tube) to provide optimal oxygenation and ventilation in critically ill patients of all ages. For providers in these settings, a deeper understanding of the indications, associated medications, and adjunctive techniques may maximize success with this common procedure. Identification of difficult airways, using mnemonics and standardized criteria prior to the procedure allows, the clinician additional time for assimilation of additional resources and tools to increase the likelihood of first-pass success with intubation...
July 2018: Advanced Emergency Nursing Journal
Athanasios Chalkias, Fotios Pavlopoulos, Effie Papageorgiou, Christos Tountas, Artemis Anania, Maria Panteli, Apostolos Beloukas, Theodoros Xanthos
BACKGROUND: Cardiogenic shock is a life-threatening condition and patients might require rapid sequence induction (RSI) and mechanical ventilation. In this study, we evaluated a new RSI/mechanical ventilation protocol in patients with acute myocardial infarction complicated by cardiogenic shock. METHODS: We included consecutive adult patients who were transferred to the emergency department. The RSI protocol included 5 phases: preoxygenation, pretreatment, induction/paralysis, intubation, and mechanical ventilation (PPIIM)...
August 2018: Canadian Journal of Cardiology
Tony Zitek, Ross P Berkeley, Ryan Hodnick, Ken Davis, Noam Dadon, David E Slattery
Although advances have been made in the approach to airway management, intubating critically ill patients in the Emergency Department (ED) can still be perilous. In some cases, poor peripheral perfusion may preclude obtaining a consistent or reliable pulse oximetry waveform, and the intubator will not accurately know when the patient begins to desaturate. We describe a case of a patient requiring intubation in whom we were unable to obtain a consistent pulse oximetry waveform. We utilized a novel technique in which a Biphasic Cuirass Ventilation (BCV) device was applied to maintain oxygenation and ventilation during the performance of rapid sequence intubation (RSI)...
July 18, 2018: American Journal of Emergency Medicine
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