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https://www.readbyqxmd.com/read/28915135/otolaryngologic-management-of-down-syndrome-patients-what-is-new
#1
Ethan C Bassett, Mary F Musso
PURPOSE OF REVIEW: The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported. RECENT FINDINGS: The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea-Hypopnea Index, up to 80% may have persistent OSA...
September 14, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28874303/airway-management-in-an-infant-with-a-large-supraglottic-mass-after-failed-fiberoptic-intubation
#2
Rajeev Sharma, Vidit Kaushal, Mohit Tyagi, Ashish Mittal
BACKGROUND: Fiberoptic bronchoscope-guided tracheal intubation is the gold standard for managing patients with supraglottic growths. In infants with a large and overhanging epiglottis, the success of fiberoptic-guided intubation relies heavily on the available space between the inferior surface of the epiglottis and the posterior pharyngeal wall or, more specifically, the superior surface of the supraglottic growth. CASE REPORT: We describe the inability to negotiate the tip of the fiberscope between the epiglottis and the supraglottic growth and the successful use of direct laryngoscopy to improve the available space along with the usefulness of "bubbling of air" to locate the glottic opening in an infant...
September 2, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28845544/ventilatory-choices-for-intubated-patients-during-helicopter-stretcher-winching
#3
John Hollott
INTRODUCTION: The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety...
August 28, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28750882/unrecognized-failed-airway-management-using-a-supraglottic-airway-device
#4
Veer D Vithalani, Sabrina Vlk, Steven Q Davis, Neal J Richmond
BACKGROUND: 911 Emergency Medical Services (EMS) systems utilize supraglottic devices for either primary advanced airway management, or for airway rescue following failed attempts at direct laryngoscopy endotracheal intubation. There is, however, limited data on objective confirmation of supraglottic airway placement in the prehospital environment. Furthermore, the ability of EMS field providers to recognize a misplaced airway is unknown. METHODS: Retrospective review of patients who underwent airway management using the King LTS-D supraglottic airway in a large urban EMS system, between 3/1/15-9/30/2015...
October 2017: Resuscitation
https://www.readbyqxmd.com/read/28740393/current-evidence-for-the-use-of-c-mac-videolaryngoscope-in-adult-airway-management-a-review-of-the-literature
#5
REVIEW
Fu-Shan Xue, Hui-Xian Li, Ya-Yang Liu, Gui-Zhen Yang
The C-MAC videolaryngoscope is the first Macintosh-typed videolaryngoscope. Since the advent of its original version video Macintosh system in 1999, this device has been modified several times. A unique feature of C-MAC device is its ability to provide the 2 options of direct and video laryngoscopy with the same device. The available evidence shows that in patients with normal airways, C-MAC videolaryngoscope compared with direct laryngoscopy can provide comparable or better laryngeal views and exerts less force on maxillary incisors, but does not offer conclusive benefits with regard to intubation time, intubation success, number of intubation attempts, the use of adjuncts, and hemodynamic responses to intubation...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28701849/blunt-trauma-neck-with-complete-tracheal-transection-a-diagnostic-and-therapeutic-challenge-to-the-trauma-team
#6
K N J Prakash Raju, D Anandhi, R Surendar, Ashwith Shetty, Vinay R Pandit
Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28657971/laryngeal-mask-airway-as-a-rescue-device-for-failed-endotracheal-intubation-during-scene-to-hospital-air-transport-of-combat-casualties
#7
Itai Shavit, Eliad Aviram, Yoav Hoffmann, Oded Biton, Elon Glassberg
BACKGROUND: Advanced airway management of combat casualties during scene-to-hospital air transport is challenging. Because of the short transport time, flight physicians of the Israeli military airborne combat evacuation unit are approved for the use of a laryngeal mask airway (LMA) in the event of failed endotracheal intubation (ETI). The aim of this study was to assess the effectiveness of LMA use during scene-to-hospital transport of combat casualties in Israel. PATIENTS AND METHODS: A retrospective cohort analysis of all combat casualties treated with ETI during scene-to-hospital transport over a 3-year period was carried out...
June 27, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28649575/ecmo-in-major-burn-patients-feasibility-and-considerations-when-multiple-modes-of-mechanical-ventilation-fail
#8
Jason D Kennedy, Wesley Thayer, Reuben Beuno, Kelly Kohorst, Avinash B Kumar
BACKGROUND: We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant literature. CASE PRESENTATION: The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified Parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress syndrome...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28601212/awake-cricothyrotomy-a-novel-approach-to-the-surgical-airway-in-the-tactical-setting
#9
REVIEW
Robert L Mabry, Chetan U Kharod, Brad L Bennett
Airway obstruction on the battlefield is most often due to maxillofacial trauma, which may include bleeding and disrupted airway anatomy. In many of these cases, surgical cricothyrotomy (SC) is the preferred airway management procedure. SC is an emergency airway procedure performed when attempts to open an airway using nasal devices, oral devices, or tracheal intubation have failed, or when the risks from intubation are unacceptably high. The aim of this overview is to describe a novel approach to the inevitably surgical airway in which SC is the first and best procedure to manage the difficult or failed airway...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28584516/missed-distal-tracheal-foreign-body-in-consecutive-bronchoscopies-in-a-6-year-old-boy
#10
Oghenevware Joel Eyekpegha, Uvie U Onakpoya, Perpetua O Obiajunwa, Olusola C Famurewa, Akinwumi B Ogunrombi
It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals...
January 2017: Nigerian Journal of Surgery: Official Publication of the Nigerian Surgical Research Society
https://www.readbyqxmd.com/read/28556897/claims-for-compensation-after-injuries-related-to-airway-management-a-nationwide-study-covering-15-years
#11
I Fornebo, K A Simonsen, I R K Bukholm, U E Kongsgaard
BACKGROUND: Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement. METHODS: All claims to The Norwegian System of Compensation to Patients from 1 January 2001 to 31 December 2015 within the medical specialty of anaesthesiology were studied. Data were extracted from this database for patients and coded by airway management procedures...
May 30, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28551485/spontaneous-submental-hematoma-a-pseudo-ludwig-s-phenomenon-in-101-year-old-patient-case-report-and-literature-review
#12
Uthman Alamoudi, Yasser Alsallumi, Matthew H Rigby, S Mark Taylor, Jonathan R B Trites, Robert D Hart
OBJECTIVE: Submental hematoma or pseudo-Ludwig's phenomenon, is a rare entity seen in anticoagulated patients and can precipitate upper airway obstruction. Our objective is to present a rare case of spontaneous submental hematoma due to poorly controlled hypertension in elderly patient and to perform a literature review. CASE REPORT: 101-year-old female presented to emergency room with sudden painful swelling in the floor of mouth and slurred speech. Not on anticoagulation and no history of trauma or known allergies...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28534235/nasal-high-flow-in-management-of-children-with-status-asthmaticus-a-retrospective-observational-study
#13
Florent Baudin, Alexandra Buisson, Blandine Vanel, Bruno Massenavette, Robin Pouyau, Etienne Javouhey
BACKGROUND: Asthma is the most common obstructive airway disease in children and adults. Nasal high flow (NHF) is a recent device that is now used as a primary support for respiratory distress. Several studies have reported use of NHF as a respiratory support in status asthmaticus; however, there are no data to recommend such practice. We therefore conducted this preliminary study to evaluate NHF therapy for children with status asthmaticus admitted to our PICU in order to prepare a multicentre randomized controlled study...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28459305/advanced-airway-type-and-its-association-with-chest-compression-interruptions-during-out-of-hospital-cardiac-arrest-resuscitation-attempts
#14
Angela F Jarman, Christy L Hopkins, J Nicholas Hansen, Jonathan R Brown, Christopher Burk, Scott T Youngquist
OBJECTIVE: To assess interruptions in chest compressions associated with advanced airway placement during cardiopulmonary resuscitation (CPR) of out-of-hospital cardiac arrest (OHCA) victims. METHODS: The method used was observational analysis of prospectively collected clinical and defibrillator data from 339 adult OHCA victims, excluding victims with <5 minutes of CPR. Interruptions in CPR, summarized by chest compression fraction (CCF), longest pause, and the number of pauses greater than 10 seconds, were compared between patients receiving bag valve mask (BVM), supraglottic airway (SGA), endotracheal intubation (ETI) via direct laryngoscopy (DL), and ETI via video laryngoscopy (VL)...
September 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28443268/complicated-postoperative-course-after-pulmonary-artery-sling-repair-and-slide-tracheoplasty
#15
Angelika Weber, Birgit Donner, Marie-Hélène Perez, Stefano Di Bernardo, Daniel Trachsel, Kishore Sandu, Nicole Sekarski
Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28441963/in-hospital-airway-management-training-for-non-anesthesiologist-ems-physicians-a-descriptive-quality-control-study
#16
Helmut Trimmel, Christoph Beywinkler, Sonja Hornung, Janett Kreutziger, Wolfgang G Voelckel
BACKGROUND: Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer's qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. METHODS: In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt...
April 26, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28419806/tracheal-t-tubes-for-long-term-management-of-the-unreconstructable-trachea-in-adults
#17
Mark A Varvares
Management of tracheostenosis in adult patients who are either medically unreconstructable due to significant comorbidities or surgically unreconstructable remains a challenge. The tracheal T-tube offers an excellent permanent solution to the problem of the unreconstructable trachea. This article reviews 3 patients who underwent tracheofissure and placement of a tracheal T-tube after failed prior attempts at repair of tracheal stenosis. The tracheal T-tubes have been maintained for 13, 15, and 36 years, and these patients have enjoyed adequate phonatory and respiratory functions with the T-tube plugged and functioning as an airway stent...
July 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28403406/comparison-of-effectiveness-of-two-commonly-used-two-handed-mask-ventilation-techniques-on-unconscious-apnoeic-obese-adults
#18
M Fei, J L Blair, M J Rice, D A Edwards, Y Liang, M A Pilla, M S Shotwell, Y Jiang
Background.: Mask ventilation and tracheal intubation are basic techniques for airway management and mutually inclusive rescue measures to restore ventilation. The aim of this study was to compare the effectiveness of mask ventilation between two commonly used techniques of two-handed mask ventilation in obese unconscious apnoeic adults. Methods.: Eighty-one obese adults received mask ventilation after induction using C-E clamp and modified V-E clamp techniques in a randomized crossover manner...
April 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28373921/successful-extubation-using-heliox-bipap-in-two-patients-with-postextubation-stridor
#19
Pragya Punj, Premkumar Nattanmai, Pravin George, Christopher R Newey
Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.e., combination of helium and oxygen) in managing patients with postextubation stridor has not been fully established. We report two cases of postextubation stridor successfully treated with heliox delivered with bilevel positive airway pressure (BiPAP) after failure of standard medical therapy...
2017: Case Reports in Pulmonology
https://www.readbyqxmd.com/read/28366293/procedural-difficulties-during-successful-intubation-in-octogenarians-a-prospective-observational-study
#20
Y F Bryan, K N Johnson
OBJECTIVE: Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks. MATERIALS AND METHODS: An institutional review board-approved difficult airway prospective observational study in older adults was conducted...
March 30, 2017: Revista Española de Anestesiología y Reanimación
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