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AIME Airway

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1830 papers 1000+ followers Airway Interventions & Management in Emergencies AIME for airway success aimeairway.ca
https://read.qxmd.com/read/31335755/ketamine-propofol-admixture-vs-etomidate-for-intubation-in-the-critically-ill-keep-pace-randomized-clinical-trial
#1
Nathan J Smischney, Wayne T Nicholson, Daniel R Brown, Alice Gallo De Moraes, Sumedh S Hoskote, Brian Pickering, Richard A Oeckler, Vivek N Iyer, Ognjen Gajic, Darrell R Schroeder, Philippe R Bauer
BACKGROUND: Peri-intubation hypotension is associated with poor outcomes in the critically-ill. We aimed to determine if an admixture of ketamine and propofol for emergent endotracheal intubation in critically-ill patients was superior to etomidate. Primary endpoint was the change in mean arterial pressure from baseline to 5 minutes post-drug administration. METHODS: Emergent-use, stratified (shock status and unit type), multi-unit, randomized, parallel-group superiority clinical trial was conducted at a tertiary academic medical center...
July 16, 2019: Journal of Trauma and Acute Care Surgery
https://read.qxmd.com/read/31359434/checking-mask-ventilation-before-neuromuscular-block-a-nation-wide-survey-of-anaesthetists-attitudes-and-thinking
#2
Marcus Saastamoinen, Jan Larsson, Peter Frykholm
BACKGROUND: The value of checking mask ventilation before administering neuromuscular blocking drugs is still debated. METHOD: We conducted a survey of the practice of anaesthetists in Sweden, first asking if they use a mask ventilation trial (MVT) as part of routine induction with intubation (not rapid sequence induction or expected difficult airway). We focused on the reasons for or against the MVT, probing the anaesthetists' attitudes in general but also in specific scenarios...
July 29, 2019: Acta Anaesthesiologica Scandinavica
https://read.qxmd.com/read/31360823/heart-rate-variability-and-acute-stress-among-novice-airway-managers
#3
Jason M Mefford, Sarah Kahle, Shikha Gupta, Daniel Tancredi, Aaron R Danielson, Samuel O Clarke
Background: The nature of medical emergencies places emergency physicians at risk for high levels of acute psychological stress (APS). Stress-modifying techniques like visualization, breath control, and mental practice may help mitigate APS, but objective markers of stress are difficult to measure in the clinical setting. We explored the relationship between heart rate variability (HRV), a real-time measure of autonomic arousal, and self-reported APS among emergency medicine (EM) residents learning to intubate on actual patients...
July 2019: AEM education and training
https://read.qxmd.com/read/31362899/successful-intubation-of-a-difficult-airway-using-a-yankauer-suction-catheter
#4
Keshav Patel, Joshua Mastenbrook, Aaron Pfeifer, Laura Bauler
BACKGROUND: Endotracheal intubation (ETI) is used to effectively manage a patient's airway. Failure of ETI may lead to ineffective ventilation or oxygenation, potentially causing organ damage and eventually death. Approximately 8% of ETIs are difficult and 1% are unsuccessful. Tools and techniques to successfully obtain airway access are essential. CASE REPORT: A patient with chronic obstructive pulmonary disease presented to the emergency department in acute respiratory distress...
July 27, 2019: Journal of Emergency Medicine
https://read.qxmd.com/read/31213571/the-use-of-high-flow-nasal-cannula-oxygen-outside-the-icu
#5
Sasson Zemach, Yigal Helviz, Michal Shitrit, Reuven Friedman, Phillip D Levin
BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is a routine, evidence-based treatment in the ICU. Due to its ease of application, non- evidence-based use of HFNC has spread to non-ICU wards. This study reports on the experience with HFNC outside the ICU. METHODS: This is an observational study of HFNC prescribed by treating physicians in non-ICU areas. Primary outcomes included change in dyspnea visual analog scale score and physiological variables both before and 30 min after initiation of HFNC treatment...
June 18, 2019: Respiratory Care
https://read.qxmd.com/read/31220910/dexmedetomidine-present-and-future-directions
#6
Seongheon Lee
Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response which shows easy transition from sleep to wakefulness, allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium compared with other sedatives, or even prevent delirium. Analgesic effect of dexmedetomidine is not strong, however, it can be administered as a useful analgesic adjuvant...
June 21, 2019: Korean Journal of Anesthesiology
https://read.qxmd.com/read/31222272/preventing-unnecessary-intubations-a-5-year-regional-burn-center-experience-using-flexible-fiberoptic-laryngoscopy-for-airway-evaluation-in-patients-with-suspected-inhalation-or-airway-injury
#7
Shawn Moshrefi, Clifford C Sheckter, Kimberly Shepard, Clifford Pereira, Drew J Davis, Yvonne Karanas, Danielle H Rochlin
The decision to intubate acute burn patients is often based on the presence of classic clinical exam findings. However, these findings may have poor correlation with airway injury and result in unnecessary intubation. We investigated flexible fiberoptic laryngoscopy (FFL) as a means to diagnose upper airway thermal and inhalation injury and guide airway management. A retrospective chart review of all burn patients who underwent FFL from 2013 to 2017 was performed. Their charts were reviewed to determine the indications for FFL including the historical data and physical exam findings that indicated airway injury as well as patient age, TBSA, type and depth of burn injury, carboxyhemoglobin level, and clinical course...
April 26, 2019: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://read.qxmd.com/read/31226878/improving-post-intubation-analgesia-in-the-emergency-department
#8
Kelly Howe, Bryan Imhoff, Sam Wagner
No abstract text is available yet for this article.
June 21, 2019: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://read.qxmd.com/read/31231508/recent-advances-in-laryngoscopy-in-adults
#9
REVIEW
Matteo Parotto, Richard Cooper
Recent advances in technology have made laryngoscopy less dependent upon a direct line of sight to achieve tracheal intubation. Whether these new devices are useful tools capable of increasing patient safety depends upon when and how they are used. We briefly consider the challenges in reviewing the emerging literature given the variety of devices, "experience" of the care providers, the clinical settings, and the definitions of outcome. We examine some of the limitations of conventional direct laryngoscopy, question the definitions we have used to define success, discuss the benefits of indirect (video) techniques, and review evidence pertaining to their use in the patients in the operating room, emergency department, and intensive care unit...
2019: F1000Research
https://read.qxmd.com/read/31235218/adoption-of-low-tidal-volume-ventilation-in-the-emergency-department-a-quality-improvement-intervention
#10
Matthew E Prekker, Crystal Donelan, Sum Ambur, Brian E Driver, Alex O'Brien-Lambert, Daniel G Hottinger, Alexander B Adams
BACKGROUND: Ventilator tidal volumes of >8 mL/kg of predicted body weight (PBW) may increase the risk of lung injury. We sought to evaluate the impact of a quality improvement intervention among intubated Emergency Department (ED) patients to protocolize the prescription of low tidal volume ventilation. METHODS: In this before-and-after study, the average tidal volume delivered to ED patients receiving volume assist-control ventilation was compared before (2007-2014) and after (2015-2016) implementation of a ventilator initiation protocol (the quality improvement intervention)...
June 15, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/31238034/association-of-patient-age-with-first-pass-success-in-out-of-hospital-advanced-airway-management
#11
Jeffrey L Jarvis, David Wampler, Henry E Wang
BACKGROUND: First pass advanced airway insertion success is associated with fewer adverse events. We sought to compare out-of-hospital endotracheal intubation (ETI) and supraglottic airway (SGA) first-pass success (FPS) rates between adults and children in a national cohort of EMS agencies. METHODS: We analyzed data from 2017 using a national cohort of 731 EMS agencies. Using multivariable logistic regression, we compared the odds of ETI and SGA FPS between adult (age >14 years) and pediatric (age ≤14 years) patients, adjusting for gender, ethnicity, indication, and drug facilitation...
June 22, 2019: Resuscitation
https://read.qxmd.com/read/31248536/effectiveness-of-manual-ventilation-in-intubated-helicopter-emergency-services-transported-trauma-patients
#12
Brett McLachlan, Craig Bilbrey, Keith Mausner, Timothy J Lenz
BACKGROUND: Helicopter Emergency Medical Services agencies frequently transport intubated patients to definitive care. No evidence exists to determine the type of ventilation in this population. Practice varies amongst programs from bag-valve-mask to mechanical ventilation. STUDY OBJECTIVE: Evaluate the effectiveness of bag-valve ventilation in intubated trauma patients. We hypothesized manual ventilation provides adequate support to maintain physiologic ETCO2 ...
July 2019: Air Medical Journal
https://read.qxmd.com/read/31248674/procedural-experience-with-intubation-results-from-a-national-emergency-medicine-group
#13
Jestin N Carlson, Mark Zocchi, Karla Marsh, Chloe McCoy, Jesse M Pines, Adam Christensen, Rebecca Kornas, Arvind Venkat
STUDY OBJECTIVE: Although intubation is a commonly discussed procedure in emergency medicine, the number of opportunities for emergency physicians to perform it is unknown. We determine the frequency of intubation performed by emergency physicians in a national emergency medicine group. METHODS: Using data from a national emergency medicine group (135 emergency departments [EDs] in 19 states, 2010 to 2016), we determined intubation incidence per physician, including intubations per year, intubations per 100 clinical hours, and intubations per 1,000 ED patient visits...
June 24, 2019: Annals of Emergency Medicine
https://read.qxmd.com/read/31251423/factors-predicting-difficult-endotracheal-intubation
#14
Brit Long, Alex Koyfman, Michael Gottlieb
No abstract text is available yet for this article.
June 28, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/31254849/increasing-support-by-nasal-high-flow-acutely-modifies-the-rox-index-in-hypoxemic-patients-a-physiologic-study
#15
Tommaso Mauri, Eleonora Carlesso, Elena Spinelli, Cecilia Turrini, Francesca Dalla Corte, Riccarda Russo, Jean-Damien Ricard, Antonio Pesenti, Oriol Roca, Giacomo Grasselli
The ROX (Respiratory rate-OXygenation) index is an early predictor of failure of nasal high flow (NHF), with lower values indicating higher risk of intubation. We measured the ROX index at set flow rate of 30 and 60 l/min in 57 hypoxemic patients on NHF. Patients with increased ROX index values at higher flow (n = 40) showed worse baseline oxygenation, higher respiratory rate and lower ROX index in comparison to patients with unchanged or decreased ROX index values (n = 17). The ROX index variation between flows was correlated with the change in end expiratory lung volume...
October 2019: Journal of Critical Care
https://read.qxmd.com/read/31255428/multiple-intubation-attempts-in-the-emergency-department-and-in-hospital-mortality-a-retrospective-observational-study
#16
Syunsuke Yamanaka, Ran D Goldman, Tadahiro Goto, Hiroyuki Hayashi
OBJECTIVES: Multiple intubation attempts in the Emergency Department (ED) have been associated with adverse events, but no study examined the influence of multiple intubation attempts on survival during hospitalization. Our aim was to compare one or more intubation attempts in the ED with risk of morbidity and mortality during hospitalization. METHODS: We conducted a single center retrospective analysis of all patients undergoing emergency intubation in the ED and then admission to the hospital, during September 2010 to April 2016...
June 20, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/31257718/effect-of-the-introduction-of-c-mac-videolaryngoscopy-on-first-pass-intubation-success-rates-for-emergency-medicine-registrars
#17
Stephanie Mackie, Fen Moy, Sinan Kamona, Peter Jones
OBJECTIVES: The present study investigated the impact of introducing C-MAC videolaryngoscopy as the standard method of visualising glottic structures on first-pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand. METHODS: In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C-MAC videolaryngoscopy were compared...
June 30, 2019: Emergency Medicine Australasia: EMA
https://read.qxmd.com/read/31262413/mechanical-ventilation-in-hypoxemic-respiratory-failure
#18
REVIEW
Shikha Kapil, Jennifer G Wilson
Acute hypoxemic respiratory failure (AHRF) is a common challenge in emergency medicine. Patient outcomes depend on interventions performed during preintubation, intubation, and postintubation. The article presents recommendations for evidence-based practice to optimally manage patients with AHRF and the acute respiratory distress syndrome.
August 2019: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/31262421/extubation-in-the-emergency-department-and-resuscitative-unit-setting
#19
REVIEW
Chidinma C Nwakanma, Brian Joseph Wright
A subset of intubated patients can safely be extubated in the emergency department (ED). The emergency medicine provider should be prepared for both common and life-threatening complications if considering ED extubation. Patients selected for extubation in the ED should have a low or near zero risk of reintubation or extubation failure. Intensive nursing care, close monitoring, and the ability to reintubate are minimum requirements for EDs considering ED extubation. This article provides a framework for determining appropriate patients for extubation and a practical approach on how to safely perform the procedure...
August 2019: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/31264388/endotracheal-intubation-by-a-specialised-paediatric-retrieval-team
#20
John Glasheen, Paul Holmes, Neeta Rampersad, Sainath Raman
OBJECTIVES: Intubation of critically ill children is an infrequent procedure, and is associated with significant risk. We set out to describe intubations carried out by the Children's Health Queensland Retrieval Service (CHQRS), with the intention to identify areas for improvement in the performance of intubation in the retrieval setting. METHODS: Paediatric patients undergoing transport while intubated were identified, and cases where intubation occurred after the arrival of the CHQRS team were examined...
July 1, 2019: Emergency Medicine Australasia: EMA
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