Camille Legoux, Richard Gerein, Kathy Boutis, Nicholas Barrowman, Amy Plint
Objective: While short-term gains in performance of critical emergency procedures are demonstrated after simulation, long-term retention is relatively uncertain. Our objective was to determine whether simulation of critical emergency procedures promotes long-term retention of skills in nonsurgical physicians. Methods: We searched multiple electronic databases using a peer-reviewed strategy. Eligible studies 1) were observational cohorts, quasi-experimental or randomized controlled trials; 2) assessed intubation, cricothyrotomy, pericardiocentesis, tube thoracostomy, or central line placement performance by nonsurgical physicians; 3) utilized any form of simulation; and 4) assessed skill performance immediately after and at ≥ 3 months after simulation...
July 2021: AEM Education and Training
Ahmer Irfan, Kavina Juneja, Peter Abraham, W Andrew Smedley, Shannon W Stephens, Russell L Griffin, William Ward, Robert Hallmark, Zaffer Qasim, Shannon L Carroll, Donald Reiff, John B Holcomb, Jan O Jansen
BACKGROUND: Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision-making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical U...
May 10, 2021: Journal of Trauma and Acute Care Surgery
Steven Rosenbaum, R Gentry Wilkerson, Michael E Winters, Gary M Vilke, Marie Yung Chen Wu
BACKGROUND: Angioedema is a complication that has been reported in up to 1.0% of individuals taking angiotensin-converting enzyme inhibitors (ACE-Is). Importantly, the onset of angioedema can occur anywhere from hours to several years after initiation of therapy with ACE-Is. Although most cases of ACE-I-induced angioedema (ACE-I-AE) are self-limiting, a major clinical concern is development of airway compromise, which can potentially require emergent airway management. The underlying pathophysiology of ACE-I-AE is incompletely understood, but is considered to be due in large part to excess bradykinin...
May 15, 2021: Journal of Emergency Medicine
Christopher P Lee, Yu-Yeung Yip, Albert Km Chan, Chun P Ko, Gavin M Joynt
COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a surrogate for contamination. Twenty anaesthetists and intensivists intubated a simulated patient with COVID-19. The primary outcome was the degree of contamination. The secondary outcomes included the use of bag-valve-mask ventilation, the incidence of manikin cough, intubation time, first attempt success and heart rate variability as a measure of stress...
May 26, 2021: Anaesthesia and Intensive Care
Prince Vaid, Eric Farrell, Martin Donnelly
AIMS: Acute supraglottitis (AS) can be a life threatening infection that may lead to sudden airway obstruction. Thankfully, paediatric instances have decreased with public health vaccination programmes. Owing to the nature of the location of pathology, this time sensitive emergency requires astute clinical acumen and awareness of early warning signs. This study aimed to i) determine if the incidence of AS has changed over time; ii) investigate geographical and seasonal variation of infection; iii) identify features of presentation which may predict airway intervention; iv) assess efficacy of treatment and make recommendations for management...
May 19, 2021: American Journal of Otolaryngology
Christopher Wilkerson, Andrew T Dailey
Spinal cord injury (SCI) affects approximately 54 per 1 million people annually in the United States. Treatment strategies for this patient population focus on initial stabilization and early intervention. The cornerstones of early management are clinical assessment, characterization of the injury, medical optimization, and definitive surgical treatment, including surgical stabilization and/or decompression. This article discusses the important strategies in caring for patients with SCI that are supported with significant literature...
July 2021: Neurosurgery Clinics of North America
T M Cook, E O'Sullivan, F E Kelly
No abstract text is available yet for this article.
July 2021: Anaesthesia
Dominique Savary, Delphine Douillet, François Morin, Adrien Drouet, Thomas Moumned, Pierre Metton, Bruno Carneiro, Marc Fadel, Alexis Descatha
INTRODUCTION: Traumatic cardiac arrest (TCA) guidelines emphasize specific actions that aim to treat the potential reversible causes of the arrest. The aim of this study was to measure the impact of these recommendations on specific rescue measures carried out in the field, and their influence on short-term outcomes in the resuscitation of TCA patients. METHODS: We conducted a retrospective study of all TCA patients treated in two emergency medical units, which are part of the Northern Alps Emergency Network, from January 2004 to December 2017...
May 31, 2021: Resuscitation
Nadir Elias, James Thomas, Allen Cheng
The larynx is a complex anatomic structure and a properly functioning larynx is essential for breathing, voice, and swallowing. Laryngeal trauma is often associated with other injuries, including intracranial injuries, penetrating neck injuries, cervical spine fractures, and facial fractures. Although uncommon, laryngotracheal injuries may lead to life-threatening airway emergencies. Because laryngeal injuries are rare, even surgeons with a great deal of experience in managing maxillofacial trauma have limited exposure to management of laryngeal and tracheal injury...
June 4, 2021: Oral and Maxillofacial Surgery Clinics of North America
Tara Glenn, Shwetha Sudhakar, Ashley Markowski, Sindhoosha Malay, Anna Maria Hibbs
INTRODUCTION: Complications of neonatal intubation are known to be increased with emergent intubations, increased number of attempts, unstable hemodynamics, or ventilation failure; and decreased with use of paralytic medication and videolaryngoscopy. Patient characteristics associated with complications are not well understood. DESIGN/METHODS: A retrospective cohort study was performed of neonates who underwent intubation between January 2017 and June 2019. Patient characteristics of infants with and without complications were compared...
May 13, 2021: Pediatric Pulmonology
Pascale Avery, Sarah Morton, James Raitt, Hans Morten Lossius, David Lockey
BACKGROUND: Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI - training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described...
May 13, 2021: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Paul Fennessy, Eugene Greco, Nicholas Gelber, David J Brewster, John H Reeves
BACKGROUND: Emergency front-of-neck airway rescue is recommended in a can't intubate, can't oxygenate clinical scenario. Cannula cricothyroidotomy has been reported as having a high failure rate. Our primary aim was to estimate the angle of the trachea in relation to the horizontal axis in a simulated emergency front-of-neck airway rescue position. Our secondary aims were to estimate the optimal cannula angle of approach and evaluate the anatomical relationship of the cricothyroid membrane (CTM) to adjacent structures...
July 1, 2021: Anesthesia and Analgesia
Akshilkumar Patel, Robert Saadi, Jessyka G Lighthall
Study Design: The present study is a systematic review of the literature. Objective: The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Methods: Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered...
June 2021: Craniomaxillofacial Trauma & Reconstruction
Ji-Hyun Lee, Sung-Ae Cho, Hyun-Woo Choe, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: An optimal endotracheal tube (ETT) curve can be a key factor in successful intubation using the GlideScope videolaryngoscope. AIMS: This study aimed to evaluate the effects of tube tip-modified stylet curve on the intubation time in children METHODS: Children aged 1-5 years were randomly assigned to either the standard curve (group S, n=60) or tip-modified curve (group T, n=60) groups. In group S, the ETT curve was similar to that in the GlideScope. In group T, a point approximately 1...
May 17, 2021: Paediatric Anaesthesia
Kuo-Chuan Hung, Jen-Yin Chen, I-Jung Feng, Min-Hsien Chiang, Shao-Chun Wu, I-Wen Chen, Yao-Tsung Lin, Ying-Jen Chang, Zhi-Fu Wu, Hsiao-Feng Lu, Cheuk-Kwan Sun
BACKGROUND: Despite reported superior intubation outcomes associated with Parker Flex-Tip (PFT) tubes compared with those associated with standard polyvinylchloride tubes, the efficacy and safety of PFT tubes remain uncertain. OBJECTIVES: To compare the intubation outcomes between PFT and conventional standard polyvinylchloride tubes. DESIGN: Meta-analysis of randomised controlled trials.DATA SOURCES Embase, Medline, Google Scholar, PubMed and the Cochrane controlled trials register from inception until 3 January 2021...
May 14, 2021: European Journal of Anaesthesiology
Berthold Moser, Michael Kemper, Maren Kleine-Brueggeney, Lukas Gasteiger, Markus Weiss
BACKGROUND: Flexible bronchoscope-guided tracheal intubation through supraglottic airway devices (SGAs) is a well-established element of difficult intubation algorithms. Success can be limited by dimensional incompatibilities between tracheal tubes (TTs) and SGAs. METHODS: In this in vitro study, we tested the feasibility of TT passage through SGAs, removal of SGAs over TTs, and the ability to guide the flexible bronchoscope with 13 TT brands (internal diameter, 6...
May 20, 2021: Canadian Journal of Anaesthesia
Teiji Sawa, Atsushi Kainuma, Koichi Akiyama, Mao Kinoshita, Masayuki Shibasaki
Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS)...
2021: Frontiers in Pediatrics
Nurfadilah Mahli, Jaafar Md Zain, Siti Nidzwani Mohamad Mahdi, Yeoh Chih Nie, Liu Chian Yong, Ahmad Fairuz Abdul Shokri, Muhammad Maaya
This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view...
2021: Frontiers in Medicine
Samir Jaber, Amélie Rollé, Thomas Godet, Nicolas Terzi, Béatrice Riu, Pierre Asfar, Jeremy Bourenne, Séverin Ramin, Virginie Lemiale, Jean-Pierre Quenot, Christophe Guitton, Eloi Prudhomme, Cyril Quemeneur, Raiko Blondonnet, Mathieu Biais, Laurent Muller, Alexandre Ouattara, Martine Ferrandiere, Piehr Saint-Léger, Thomas Rimmelé, Julien Pottecher, Gerald Chanques, Fouad Belafia, Claire Chauveton, Helena Huguet, Karim Asehnoune, Emmanuel Futier, Elie Azoulay, Nicolas Molinari, Audrey De Jong
PURPOSE: The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone. METHODS: In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet)...
May 25, 2021: Intensive Care Medicine
Brian Driver, Matthew W Semler, Wesley H Self, Adit A Ginde, Sheetal Gandotra, Stacy A Trent, Lane M Smith, John P Gaillard, David B Page, Micah R Whitson, Derek J Vonderhaar, A M Joffe, Jason R West, Christopher Hughes, Janna S Landsperger, Michelle P Howell, Derek W Russell, Swati Gulati, Itay Bentov, Steven Mitchell, Andrew Latimer, Kevin Doerschug, Vikas Koppurapu, Kevin W Gibbs, Li Wang, Christopher John Lindsell, David Janz, Todd W Rice, Matthew E Prekker, Jonathan D Casey
INTRODUCTION: Intubation-related complications are less frequent when intubation is successful on the first attempt. The rate of first attempt success in the emergency department (ED) and intensive care unit (ICU) is typically less than 90%. The bougie, a semirigid introducer that can be placed into the trachea to facilitate a Seldinger-like technique of tracheal intubation and is typically reserved for difficult or failed intubations, might improve first attempt success. Evidence supporting its use, however, is from a single academic ED with frequent bougie use...
May 25, 2021: BMJ Open
2021-06-08 15:44:12
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