Andrew J Latimer, Brenna Harrington, Catherine R Counts, Katelyn Ruark, Charles Maynard, Taketo Watase, Michael R Sayre
STUDY OBJECTIVE: The bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie. METHODS: A prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt...
December 17, 2020: Annals of Emergency Medicine
Christopher E Jensen, Katherine A Despotes, Benjamin DeMarco
No abstract text is available yet for this article.
December 21, 2020: Chest
Erin L Simon, Courtney M Smalley, Stephen W Meldon, Bradford L Borden, Isaac Briskin, McKinsey R Muir, Andrew Suchan, Fernando Delgado, Baruch S Fertel
Background: Emergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP). Methods: This was a retrospective study evaluating emergency physician procedural performance over a 12-month period...
December 2020: Journal of the American College of Emergency Physicians open
David Leasa, Paul Cameron, Kimia Honarmand, Tina Mele, Karen J Bosma
Providing optimal care to patients with acute respiratory illness while preventing hospital transmission of COVID-19 is of paramount importance during the pandemic; the challenge lies in achieving both goals simultaneously. Controversy exists regarding the role of early intubation versus use of non-invasive respiratory support measures to avoid intubation. This review summarizes available evidence and provides a clinical decision algorithm with risk mitigation techniques to guide clinicians in care of the hypoxemic, non-intubated, patient during the COVID-19 pandemic...
January 8, 2021: Critical Care: the Official Journal of the Critical Care Forum
Ryan Howle, Desire Onwochei, Siew-Ling Harrison, Neel Desai
PURPOSE: The incidence of difficult and failed intubation is higher in obstetrical patients than in the general population because of anatomic and physiologic changes in pregnancy. Videolaryngoscopy improves the success rate of intubation and reduces complications when compared with direct laryngoscopy in adults; however, it is not known whether this extends to obstetrical surgery. The aim of this study was to examine the efficacy, efficiency, and safety of videolaryngoscopy compared with direct laryngoscopy in obstetrics...
January 12, 2021: Canadian Journal of Anaesthesia
Chao Zhang, Min Ou
BACKGROUND: Optimization of preoxygenation procedure can help to secure the method of intubation by reducing the risks of severe hypoxemia and other problems. There is confusion for efficacy of non-invasive ventilation compared to high-flow oxygen therapy regarding occurrence of severe hypoxemia during the intubation procedure. The purpose of the study was to compare the difference between noninvasive ventilation and high flow oxygen therapy to prevent desaturation during laryngoscopy...
January 14, 2021: BMC Emergency Medicine
Catherine A Gao, Joseph I Bailey, James M Walter, John M Coleman, Elizabeth S Malsin, A Christine Argento, Michelle H Prickett, Richard G Wunderink, Sean B Smith
No abstract text is available yet for this article.
January 15, 2021: Annals of the American Thoracic Society
Sheila Nainan Myatra
PURPOSE OF REVIEW: To provide an evidence-based approach to improve first pass success in tracheal intubation while maintaining patient safety in the critically ill. RECENT FINDINGS: Despite advances in the management of critically ill patients, tracheal intubation in these patients remains a high-risk procedure associated with increased morbidity and mortality. Recent interventions to enhance patient safety and improve first pass success in tracheal intubation emphasize reducing repeated attempts at tracheal intubation, oxygen desaturation and cardiovascular collapse during airway management by optimizing patient physiology to mitigate risks and reduce complications...
February 1, 2021: Current Opinion in Critical Care
Rachel Bridwell, Michael Gottlieb, Alex Koyfman, Brit Long
BACKGROUND: Ludwig's angina is a potentially deadly condition that must not be missed in the emergency department (ED). OBJECTIVE: The purpose of this narrative review article is to provide a summary of the epidemiology, pathophysiology, diagnosis, and management of Ludwig's angina with a focus on emergency clinicians. DISCUSSION: Ludwig's angina is a rapidly spreading infection that involves the floor of the mouth. It occurs more commonly in those with poor dentition or immunosuppression...
December 23, 2020: American Journal of Emergency Medicine
Matt Hansen, Lynn White, Geneva Whitmore, Amber Lin, Rob Walker
Objective: To evaluate physiologic monitoring in pediatric patients undergoing out-of-hospital advanced airway management. Methods: Retrospective case series of pediatric patients (<18 years) with advanced airways placed in the out-of-hospital setting. Patients given cardiopulmonary resuscitation (CPR) or defibrillation before the first advanced airway attempt were excluded. Reviewers abstracted physiologic data from the patient monitor files and patient care reports...
December 2020: Journal of the American College of Emergency Physicians open
Yuen Chin Leong, Sheldon Cheskes, Ian R Drennan, Jason E Buick, Ron G Latchmansingh, P Richard Verbeek
Managing out-of-hospital cardiac arrest requires paramedics to perform multiple aerosol generating medical procedures in an uncontrolled setting. This increases the risk of cross infection during the COVID-19 pandemic. Modifications to conventional protocols are required to balance paramedic safety with optimal patient care and potential stresses on the capacity of critical care resources. Despite this, little specific advice has been published to guide paramedic practice. In this commentary, we highlight challenges and controversies regarding critical decision making around initiation of resuscitation, airway management, mechanical chest compression, and termination of resuscitation...
December 2020: Resuscitation plus
Kate Crewdson, Ainsley Heywoth, Marius Rehn, Samy Sadek, David Lockey
BACKGROUND: Efficient and timely airway management is universally recognised as a priority for major trauma patients, a proportion of whom require emergency intubation in the pre-hospital setting. Adverse events occur more commonly in emergency airway management, and hypoxia is relatively frequent. The aim of this study was to establish whether passive apnoeic oxygenation was effective in reducing the incidence of desaturation during pre-hospital emergency anaesthesia. METHODS: A prospective before-after study was performed to compare patients receiving standard care and those receiving additional oxygen via nasal prongs...
January 7, 2021: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jens Otto Mæhlen, Roger Mikalsen, Hans Julius Heimdal, Marius Rehn, Jostein S Hagemo, William Ottestad
OBJECTIVE: Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. We report three patients with critical respiratory failure due to Covid-19, in which all presented with severe hypoxemia refractory to supplemental oxygen therapy. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting, and point out some pitfalls regarding the management of these patients. Guidelines for pre-hospital care of critically ill Covid-19 patients cannot be established based on the current evidence base, and we have to apply our understanding of respiratory physiology and mechanics in order to optimize respiratory support...
January 12, 2021: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jai Madhok, Melissa A Vogelsong, Tiffany C Lee, Jennifer G Wilson, Frederick Mihm
This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. Adherence to the airway management protocol was high. COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%-77%] vs 89% [86%-94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = ...
December 17, 2020: A&A Practice
Joshua Nagler, Marc Auerbach, Michael C Monuteaux, John A Cheek, Franz E Babl, Ed Oakley, Lucia Nguyen, Arjun Rao, Sarah Dalton, Mark D Lyttle, Santiago Mintegi, Rakesh D Mistry, Andrew Dixon, Pedro Rino, Guillermo Kohn-Loncarica, Stuart R Dalziel, Simon Craig
BACKGROUND: Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. OBJECTIVES: Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children...
December 31, 2020: American Journal of Emergency Medicine
Welawat Tienpratarn, Chaiyaporn Yuksen, Kasamon Aramvanitch, Karn Suttapanit, Yahya Mankong, Nussareen Yaemluksanalert, Sansanee Meesawad
Introduction: Application of a rigid cervical collar may interfere with the laryngeal view, and potentially lead to failed endotracheal intubation (ETI). This study aimed to compare intubation success rates while performing inline stabilization with and without cervical hard collar. Methods: This randomized prospective comparative study included paramedics working in the Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand to compare the success rates of endotracheal intubation on manikin using inline stabilization with and without cervical hard collar...
2020: Archives of Academic Emergency Medicine
C C Nestor, S Wang, M G Irwin
No abstract text is available yet for this article.
December 4, 2020: Anaesthesia
Adrian Perera, Hatem Alkouri, Toby Fogg, John Vassiliadis, John Mackenzie, Yashvi Wimalasena
Apnoeic oxygenation (ApOx) has been demonstrated to reduce the incidence of desaturation, although evidence of benefit has been conflicting depending on the technique used. The aim of this study was to compare the incidence of desaturation between patients who received ApOx via conventional nasal cannula (NC) and those who did not, using a large, multicentre airway registry. METHODS: This study is an analysis of 24 months of prospectively collected data in the Australia and New Zealand Emergency Department Airway Registry (June 2013-June 2015)...
December 9, 2020: Emergency Medicine Journal: EMJ
Brian E Driver, Matthew E Prekker, Robert F Reardon, Benjamin J Sandefur, Michael D April, Ron M Walls, Calvin A Brown
BACKGROUND: Rapid sequence intubation (RSI), defined as near-simultaneous administration of a sedative and neuromuscular blocking agent, is the most common and successful method of tracheal intubation in the emergency department. However, RSI is sometimes avoided when the physician believes there is a risk of a can't intubate/can't oxygenate scenario or critical hypoxemia because of distorted anatomy or apnea intolerance. Traditionally, topical anesthesia alone or in combination with low-dose sedation are used when physicians deem RSI too risky...
December 8, 2020: Journal of Emergency Medicine
Abhimanyu Chandel, Saloni Patolia, A Whitney Brown, A Claire Collins, Dhwani Sahjwani, Vikramjit Khangoora, Paula C Cameron, Mehul Desai, Aditya Kasarabada, Jack K Kilcullen, Steven D Nathan, Christopher S King
BACKGROUND: Optimal timing of mechanical ventilation in COVID-19 is uncertain. We sought to evaluate outcomes of delayed intubation and examine the ROX index ([SpO2 /FIO2 ]/breathing frequency) to predict weaning from high-flow nasal cannula (HFNC) in COVID-19. METHODS: We performed a multi-centered retrospective observational cohort study of subjects with respiratory failure from COVID-19 managed with HFNC. The ROX index was applied to predict HFNC success. Subjects that failed HFNC were divided into early HFNC failure (≤48 hours of HFNC therapy prior to mechanical ventilation) and late failure (>48 hours)...
December 16, 2020: Respiratory Care
2020-12-19 20:59:03
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