Brandon T Ruderman, Martina Mali, Amy H Kaji, Robert Kilgo, Susan Watts, Radosveta Wells, Alexander T Limkakeng, Joseph B Borawski, Andrea E Fantegrossi, Ron M Walls, Calvin A Brown
INTRODUCTION: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways. METHODS: We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016-December 2018)...
August 19, 2022: Western Journal of Emergency Medicine
Tomas Karlsson, Andreas Brännström, Mikael Gellerfors, Jenny Gustavsson, Mattias Günther
BACKGROUND: Emergency front-of-neck airway (eFONA) is a life-saving procedure in "cannot intubate, cannot oxygenate" (CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway...
October 11, 2022: Military Medical Research
Bartholomew Grabman, Natalie E Bulger, Brenna M Harrington, Robert G Walker, Andrew J Latimer, Bonnie D Snyder, Michael R Sayre, Charles Maynard, Nicholas J Johnson, Molly Van Dyke, Catherine R Counts
INTRODUCTION: Guidelines recommend monitoring end-tidal carbon dioxide (ET CO2 ) during out-of-hospital cardiac arrest (OHCA), though its prognostic value is poorly understood. This study investigated the relationship between ET CO2 and return of spontaneous circulation (ROSC) after defibrillation in intubated non-traumatic OHCA patients. METHODS: This retrospective, observational cohort analysis included adult OHCA patients who received a defibrillation shock during treatment by an urban EMS agency from 2015 to 2021...
October 14, 2022: Resuscitation
Kelsey A Miller, Andzelika Dechnik, Andrew F Miller, Gabrielle D'Ambrosi, Michael C Monuteaux, Phillip M Thomas, Benjamin T Kerrey, Tara Neubrand, Michael P Goldman, Monica M Prieto, Robyn Wing, Ryan Breuer, Jenn D'Mello, Andy Jakubowicz, Akira Nishisaki, Joshua Nagler
STUDY OBJECTIVE: To explore the association between video-assisted laryngoscopy (use of a videolaryngoscope regardless of where laryngoscopists direct their gaze), first-attempt success, and adverse airway outcomes. METHODS: We conducted an observational study using data from 2 airway consortiums that perform prospective surveillance: the National Emergency Airway Registry for Children (NEAR4KIDS) and a pediatric emergency medicine airway education collaborative...
October 15, 2022: Annals of Emergency Medicine
Michel Galinski, Marion Wrobel, Romain Boyer, Paul Georges Reuter, Mirko Ruscev, Guillaume Debaty, Gilles Bagou, Emilie Dehours, Juliane Bosc, Jean-Paul Lorendeau, Sybille Goddet, Kamelia Marouf, Pierre Catoire, Xavier Combes, Bruno Simonnet, Cédric Gil-Jardiné
This study was performed to identify variables potentially associated with failure of the first intubation attempt in an out-of-hospital emergency setting, considering all aspects of tracheal intubation. This observational prospective multicenter study was performed over 17 months and involved 10 prehospital emergency medical units. After each tracheal intubation, the operator was required to provide information concerning operator and patient characteristics, as well as the environmental conditions during intubation, by completing a data collection form...
October 19, 2022: Internal and Emergency Medicine
Gopikrishna M Rao, Vishwanatha M Rao, Jeremy Juang, Justin Benoit, Allen L Feng, Phillip C Song
OBJECTIVES: To develop a novel laryngoscope device capable of dynamically measuring force and torque measurements in real-time during intubation and to explore the efficacy of such a device through a face validation simulation. METHODS: The torque sensor laryngoscope is designed for use during intubation and is modeled after a standard, single-use plastic laryngoscope. After device calibration, a face validation study was performed with intubation experts in the field...
October 2022: Laryngoscope Investigative Otolaryngology
Zekarias Markos, Eyayalem Melese, Lemlem Getachew, Lidya Haddis
BACKGROUND: The Mallampati test is used to evaluate the airway to predict difficult laryngoscopy and intubation. The sitting position is the standard for this test, but it has limited practical utility due to its low sensitivity and moderate specificity in predicting difficult intubation and laryngoscopy. The supine position, on the other hand, may improve its efficacy. OBJECTIVE: To assess the Mallampati test in sitting and supine positions on predicting difficult laryngoscopy and intubation among Adult surgical patients undergoing general anesthesia in selected governmental hospitals of Addis Ababa...
October 2022: Annals of Medicine and Surgery
Carolyn M Bell, Megan A Rech, Kwame A Akuamoah-Boateng, George Kasotakis, Jeffrey D McMurray, Benjamin A Moses, Scott W Mueller, Gourang P Patel, Russel J Roberts, Ankit Sakhuja, Ann Salvator, Erika L Setliff, Christopher A Droege
Objective: To evaluate practitioner use of ketamine and identify potential barriers to use in acutely and critically ill patients. To compare characteristics, beliefs, and practices of ketamine frequent users and non-users. Methods: An online survey developed by members of the Society of Critical Care Medicine (SCCM) Clinical Pharmacy and Pharmacology Section was distributed to physician, pharmacist, nurse practitioner, physician assistant and nurse members of SCCM. The online survey queried SCCM members on self-reported practices regarding ketamine use and potential barriers in acute and critically ill patients...
October 25, 2022: Journal of Pharmacy Practice
Wenya Du, Meng Lv, Tingting Chen, Xiaxuan Sun, Jihua Wang, Haixia Zhang, Chuansong Wei, Yi Liu, Changlong Qiao, Yuelan Wang
BACKGROUND: Patients scheduled for cardiac surgery are often accompanied by cardiac dysfunction and hemodynamic instability. However, the conventional induction strategy for anesthesia using high-dose intravenous anesthetics is often associated with persistent and recurrent hypotension after tracheal intubation. The purpose of this study is to investigate the effects of topical airway anesthesia on the hemodynamic profile of patients undergoing cardiac surgery during the induction period...
2022: Frontiers in Cardiovascular Medicine
Jeremy P Hampton, Kyle Hommer, Megan Musselman, Matt Bilhimer
DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The dosing, potential adverse effects, and clinical outcomes of the most commonly utilized pharmacologic agents for rapid sequence intubation (RSI) are reviewed for the practicing emergency medicine pharmacist (EMP)...
October 28, 2022: American Journal of Health-system Pharmacy: AJHP
Michael E Winters, Kami Hu, Joseph P Martinez, Haney Mallemat, William J Brady
An emergency physician (EP) is often the first provider to evaluate, resuscitate, and manage a critically ill patient. Over the past two decades, the annual hours of critical care delivered in emergency departments across the United States has dramatically increased. During the period from 2006 to 2014, the extent of critical care provided in the emergency department (ED) to critically ill patients increased approximately 80%. During the same time period, the number of intubated patients cared for in the ED increased by approximately 16%...
October 19, 2022: American Journal of Emergency Medicine
Michael A Smith, Doantrang Dinh, Ngoc P Ly, Shan L Ward, Meghan E McGarry, Matt S Zinter
RATIONALE: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States. OBJECTIVE: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric asthma patients. METHODS: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database...
October 31, 2022: Annals of the American Thoracic Society
Jason Arthur, David Caro, Stephen Topp, Steven Chadwick, Brian Driver, Morgan Henson, Ashley Norse, Horace Spencer, Steven A Godwin, Faheem Guirgis
OBJECTIVES: The objective of this study is to identify predictors of airway compromise among patients presenting to the emergency department with angioedema in order to develop and validate a risk score to augment clinician gestalt regarding need for intubation. METHODS: Retrospective chart review of emergency department patients with a diagnosis of angioedema. After data extraction they were randomly divided into a training and test set. The training set was used to identify factors associated with intubation and to develop a model and risk score to predict intubation...
October 19, 2022: American Journal of Emergency Medicine
Brandon S Houseman, Ashley N Martinelli, Wesley D Oliver, Sandeep Devabhakthuni, Amal Mattu
BACKGROUND: Sympathetic crashing acute pulmonary edema (SCAPE) is a medical emergency in which severe, acute elevation in blood pressure results in acute heart failure and fluid accumulation in the lungs. Without prompt recognition and treatment, the condition often progresses rapidly to respiratory failure necessitating intubation and intensive care unit (ICU) admission. In addition to non-invasive positive pressure ventilation (NIPPV), high-dose nitroglycerin (HDN) has become a mainstay of treatment; however, an optimal dosing strategy has not been established...
October 18, 2022: American Journal of Emergency Medicine
Muhammad Khidir Mohd Kamil, Khadijah Poh Yuen Yoong, Abdul Muhaimin Noor Azhar, Aida Bustam, Ahmad Hariz Abdullah, Mohd Hafyzuddin Md Yusuf, Aliyah Zambri, Ahmad Zulkarnain Ahmad Zahedi, Hidayah Shafie
BACKGROUND: To assess the effectiveness of non-rebreather mask combined with low-flow nasal cannula (NRB + NC) compared to high-flow nasal cannula (HFNC) in improving oxygenation in patients with COVID-19-related hypoxemic respiratory failure (HRF). METHODS: This retrospective study was conducted in emergency departments of two tertiary hospitals from June 1 to August 31, 2021. Consecutive patients aged >18 years admitted for COVID-19-related HRF (World Health Organization criteria: confirmed COVID-19 pneumonia with respiratory rate > 30 breaths/min, severe respiratory distress, or peripheral oxygen saturation < 90% on room air) requiring NRB + NC or HFNC were screened for enrollment...
October 19, 2022: American Journal of Emergency Medicine
Esther Lee, Reem Qabas Al Shabeeb, Muhammad El Shatanofy, Collin F Mulcahy, David P Yamane, Marian L Sherman, Eric R Heinz
BACKGROUND: Providers performing endotracheal intubation are at high risk of contracting SARS-CoV-2. The objective was to assess various demographic, exposure and institutional preparedness factors affecting intubators' comfort and fear level during COVID-19 intubations. METHODS: We conducted a cross-sectional, survey-based study during the COVID-19 pandemic from September 2020 to January 2021 at a single academic medical centre in Washington, DC, USA. Inclusion criteria were healthcare providers who had an experience in intubating patients confirmed with or suspected of COVID-19...
November 3, 2022: Emergency Medicine Journal: EMJ
David H Gordon, Alexander Bracey
No abstract text is available yet for this article.
November 2, 2022: Annals of Emergency Medicine
Nicholas M Mohr, Eliezer Santos Leon, Jestin N Carlson, Brian Driver, Anusha Krishnadasan, Karisa K Harland, Patrick Ten Eyck, William R Mower, Tyler M Foley, Kelli Wallace, L Clifford McDonald, Preeta K Kutty, Scott Santibanez, David A Talan
STUDY OBJECTIVE: To describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Multicenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events...
November 3, 2022: Annals of Emergency Medicine
Jessica A Pankey, Scott Christofferson, Ginger Barrick, Brandon A Knettel, Christine Knettel
Purpose: This study aimed to evaluate the frequency at which postintubation sedation is administered following use of long-acting paralytic agents compared to short-acting paralytic agents during rapid sequence intubation performed in the emergency department. Methods: This retrospective, single-center study of intubated patients in the emergency department analyzed the difference in time to administration of additional sedation following use of a short-acting paralytic (succinylcholine) compared to use of a long-acting paralytic (rocuronium or vecuronium)...
December 2022: Hospital Pharmacy
Miao Zhou, Wen Y Xu, Sheng Xu, Qing L Zang, Qi Li, Li Tan, Yong C Hu, Ning Ma, Jian H Xia, Kun Liu, Min Ye, Fei Y Pu, Liang Chen, Li J Song, Yang Liu, Lai Jiang, Lin Gu, Zui Zou
Objective: We aimed to construct and validate machine learning models for endotracheal tube (ETT) size prediction in pediatric patients. Methods: Data of 990 pediatric patients underwent endotracheal intubation were retrospectively collected between November 2019 and October 2021, and separated into cuffed and uncuffed endotracheal tube subgroups. Six machine learning algorithms, including support vector regression (SVR), logistic regression (LR), random forest (RF), gradient boosting tree (GBR), decision tree (DTR) and extreme gradient boosting tree (XGBR), were selected to construct and validate models using ten-fold cross validation in training set...
2022: Frontiers in Pediatrics
2022-11-25 18:04:19
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