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Ems airway

Jodi Taylor, Sarah Black, Stephen J Brett, Kim Kirby, Jerry P Nolan, Barnaby C Reeves, Maria Robinson, Chris A Rogers, Lauren J Scott, Adrian South, Elizabeth A Stokes, Matthew Thomas, Sarah Voss, Sarah Wordsworth, Jonathan R Benger
Health outcomes after out of hospital cardiac arrest (OHCA) are extremely poor, with only 7-9% of patients in the United Kingdom (UK) surviving to hospital discharge. Currently emergency medical services (EMS) use either tracheal intubation or newer supraglottic airway devices (SGAs) to provide advanced airway management during OHCA. Equipoise between the two techniques has led to calls for a well-designed randomised controlled trial. The primary objective of the AIRWAYS-2 trial is to assess whether the clinical effectiveness of the i-gel, a second-generation SGA, is superior to tracheal intubation in the initial airway management of OHCA patients in the UK...
September 30, 2016: Resuscitation
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
October 3, 2016: Prehospital Emergency Care
Mazen El Sayed, Hani Tamim, Ahel Al-Hajj Chehadeh, Amin A Kazzi
BACKGROUND: Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction...
September 19, 2016: Prehospital and Disaster Medicine
Karl Sporer, Michael Jacobs, Leo Derevin, Sue Duval, James Pointer
OBJECTIVE: To assess system-wide implementation of specific therapies focused on perfusion during cardiopulmonary resuscitation (CPR) and cerebral recovery after Return of Spontaneous Circulation (ROSC). METHODS: Before and after retrospective analysis of an out-of-hospital cardiac arrest database. Implementation trial in the urban/suburban community of Alameda County, California, USA, population 1.6 million, from November 2009-December 2012. Adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA) who received CPR and/or defibrillation...
September 14, 2016: Prehospital Emergency Care
Marie-Sophie Grave, Fritz Sterz, Alexander Nürnberger, Stergios Fykatas, Mathias Gatterbauer, Albert Friedrich Stättermayer, Andreas Zajicek, Reinhard Malzer, Dieter Sebald, Raphael van Tulder
We investigated feasibility and safety of the RhinoChill (RC) transnasal cooling system initiated before achieving a protected airway during cardiopulmonary resuscitation (CPR) in a prehospital setting.In out-of-hospital cardiac arrest (OHCA), transnasal evaporative cooling was initiated during CPR, before a protected airway was established and continued until either the patient was declared dead, standard institutional systemic cooling methods were implemented or cooling supply was empty. Patients were monitored throughout the hypothermia period until either death or hospital discharge...
August 2016: Medicine (Baltimore)
Thomas R Scaggs, David M Glass, Megan Gleason Hutchcraft, William B Weir
Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics)...
October 2016: Prehospital and Disaster Medicine
Bryan Choi, Nicholas Asselin, Catherine C Pettit, Max Dannecker, Jason T Machan, Derek L Merck, Lisa H Merck, Selim Suner, Kenneth A Williams, Gregory D Jay, Leo Kobayashi
INTRODUCTION: Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. METHODS: Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group...
August 9, 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
John J Cienki
OBJECTIVE: Obesity is a growing epidemic in the United States with increasing burden to the health care system. Management and transport of the morbidly obese (MO) pose challenges for Emergency Medical Services (EMS) providers. Though equipment and resources are being directed to the transport of the obese, little research exists to guide these efforts. To address this, the author of this study sought to assess EMS providers' perspectives on the challenges of caring for MO patients. METHODS: An anonymous, web-based survey was distributed to all active providers of prehospital transport of a large, urban, fire-based EMS system to evaluate the challenges of MO patients...
October 2016: Prehospital and Disaster Medicine
Graham Nichol, Leonard A Cobb, Lihua Yin, Charles Maynard, Michele Olsufka, Jonathan Larsen, Andrew M McCoy, Michael R Sayre
BACKGROUND: Treatment of out-of-hospital cardiac arrest (OHCA) requires prompt intervention. Better outcomes are associated with briefer time from dispatch of emergency medical services (EMS) providers to arrival on scene, application of a defibrillator or insertion of an advanced airway. We assessed whether time from receipt of a call by a telecommunicator to dispatch of EMS providers was associated with outcomes. METHODS: This was a retrospective analysis of a prospective cohort study of persons who had OHCA treated by EMS providers in Seattle, WA...
October 2016: Resuscitation
Jennifer Yip, Mayris P Webber, Rachel Zeig-Owens, Madeline Vossbrinck, Ankura Singh, Kerry Kelly, David J Prezant
BACKGROUND: After the World Trade Center (WTC) attacks on September 11, 2001, the Fire Department of the City of New York (FDNY) instituted a WTC medical monitoring and treatment program and established a data center to document health outcomes in the WTC-exposed workforce of ∼16,000 firefighters and EMS workers. METHODS: FDNY schedules routine monitoring exams every 12-18 months and physical and mental health treatment appointments, as required. RESULTS: FDNY research studies have consistently found that early arrival to work and/or prolonged work at the WTC-site increased the risks for adverse physical and mental health outcomes...
September 2016: American Journal of Industrial Medicine
Chaiyaporn Yuksen, Sorravit Sawatmongkornkul, Jarupol Tuangsirisup, Kittisak Sawanyawisuth, Yuwares Sittichanbuncha
BACKGROUND: Non-traumatic cardiac arrest is a fatal emergency condition. Its survival rate and outcomes may be better with quick and effective cardiopulmonary resuscitation (CPR). Telemedicine such as telephone or real time video has been shown to improve chest compression procedures. There are limited data on the effects of telemedicine in cardiac arrest situations in the literature particularly in Asian settings. METHODS: This study was conducted by using two simulated cardiac arrest stations during the 2014 annual Thai national conference in emergency medicine...
2016: BMC Emergency Medicine
Bryn E Mumma, Temur Umarov
BACKGROUND: Sex differences exist in the diagnosis and treatment of several cardiovascular diseases. Our objective was to determine whether sex differences exist in the use of guideline-recommended treatments in out-of-hospital cardiac arrest (OHCA). METHODS: We included adult patients with non-traumatic OHCA treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) database during 2007-2009...
August 2016: Resuscitation
M Rehn, P K Hyldmo, V Magnusson, J Kurola, P Kongstad, L Rognås, L K Juvet, M Sandberg
BACKGROUND: The Scandinavian society of anaesthesiology and intensive care medicine task force on pre-hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines. METHODS: The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations. RESULTS: We recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non-trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]...
August 2016: Acta Anaesthesiologica Scandinavica
Timo J Jama, Markku J Kuisma
UNLABELLED: Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching...
August 2016: Prehospital and Disaster Medicine
David A Pearson, R Darrell Nelson, Lisa Monk, Clark Tyson, James G Jollis, Christopher B Granger, Claire Corbett, Lee Garvey, Michael S Runyon
BACKGROUND: Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown...
August 2016: Resuscitation
Raphael van Tulder, Christoph Schriefl, Dominik Roth, Peter Stratil, Martin Thalhammer, Hermann Wieczorek, Friedrich Lausch, Andreas Zajicek, Jochen Haidvogel, Dieter Sebald, Wolfgang Schreiber, Fritz Sterz, Anton Laggner
BACKGROUND: The endotracheal tube (ETT) is considered the gold standard in emergency airway management, although supraglottic airway devices, especially the laryngeal tube (LT), have recently gained in importance. Although regarded as an emergency device in case of failure of endotracheal intubation in most systems, we investigated the dynamics of the use of the LT in a metropolitan ambulance service without any regulations on the choice of airway device. METHODS: A retrospective, observational study on all patients from the Municipal Ambulance Service, Vienna in need of advanced airway management over a 5-year period...
April 26, 2016: Prehospital Emergency Care
Elisabeth M Haisma, Anikó Göblyös, Bep Ravensbergen, Alwin E Adriaans, Robert A Cordfunke, Jasmijn Schrumpf, Ronald W A L Limpens, Kirsten J M Schimmel, Jan den Hartigh, Pieter S Hiemstra, Jan Wouter Drijfhout, Abdoelwaheb El Ghalbzouri, Peter H Nibbering
We previously found the LL-37-derived peptide P60.4Ac to be effective against methicillin-resistant Staphylococcus aureus (MRSA) on human epidermal models (EMs). The goal of this study was to identify the preferred carrier for this peptide for topical application on skin and mucosal surfaces. We prepared P60.4Ac in three formulations, i.e., a water-in-oil cream with lanolin (Softisan 649), an oil-in-water cream with polyethylene glycol hexadecyl ether (Cetomacrogol), and a hydroxypropyl methylcellulose (hypromellose) 4000 gel...
July 2016: Antimicrobial Agents and Chemotherapy
D W Healy, E J LaHart, E E Peoples, E S Jewell, R J Bettendorf, S K Ramachandran
BACKGROUND: The Mallampati examination is a standard component of an airway risk assessment. Existing evidence suggests that cervical spine extension improves the predictive power of the Mallampati examination for detecting difficult laryngoscopy and tracheal intubation, but a comparative effectiveness study has not been conducted. METHODS: The extended Mallampati examination (EMS) was introduced to the standard preoperative airway assessment, in addition to the standard Modified Mallampati examination (MMP)...
May 2016: British Journal of Anaesthesia
C Mac Donncha, N Cummins, D Hennelly, A Hannigan, D Ryan
BACKGROUND: Emergency medical services (EMS) practitioners in Ireland have been recently licensed to use continuous positive airway pressure (CPAP) ventilation for patients with pulmonary oedema. Both the British Thoracic Society and the Canadian Medical Association advocate the use of CPAP in hospital for patients with severe exacerbations of pulmonary oedema. AIMS: The aim of this study was to identify prehospital patients in the Midwest, over a 6-month period, which could potentially benefit from CPAP if it were available in the National Ambulance Service...
April 18, 2016: Irish Journal of Medical Science
Pamela Hiltunen, Helena Jäntti, Tom Silfvast, Markku Kuisma, Jouni Kurola
BACKGROUND: Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. METHODS: During a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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