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Emergent intubation

Hadil Ak AlOtair, Abdulaziz H Alzeer, Mohammed A Abdou, Shaden O Qasrawi
Central alveolar hypoventilation is rarely encountered. This case report describes a young woman who was recently diagnosed with hypertension and ischemic heart disease. She presented to the emergency room with hypercapnic respiratory failure, for which she was mechanically ventilated. This was preceded by an acute upper respiratory tract infection. She was initially suspected to have Guillain-Barré syndrome, but further investigations ruled out neuromuscular or autoimmune disorders. Sleep-related hypoventilation was suspected after she experienced recurrent apneas at night that resulted in re-intubation...
March 2018: Saudi Medical Journal
Kei Ouchi, Guruprasad D Jambaulikar, Samuel Hohmann, Naomi R George, Emily L Aaronson, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Jeremiah D Schuur, Daniel J Pallin
OBJECTIVES: To inform the shared decision-making process between clinicians and older adults and their surrogates regarding emergency intubation. DESIGN: Retrospective cohort study. SETTING: Multicenter, emergency department (ED)-based cohort. PARTICIPANTS: Adults aged 65 and older intubated in the ED from 2008 to 2015 from 262 hospitals across the United States (>95% of U.S. nonprofit academic medical centers). MEASUREMENTS: Our primary outcome was age-specific in-hospital mortality...
March 15, 2018: Journal of the American Geriatrics Society
Jonathan B Imran, Robyn E Richmond, Tarik D Madni, Kimberly Roaten, Audra T Clark, Emily Huang, Ali A Mokdad, Luis R Taveras, Kareem R Abdelfattah, Michael W Cripps, Alexander L Eastman
BACKGROUND: Trauma patients may be at elevated risk for subsequent suicide; however, it is unclear whether patients at risk can be identified during their initial presentation following injury. The objective of this study was to evaluate the use of a standardized clinical decision support system for suicide risk screening developed by our hospital system and to determine the incidence of positive suicide screenings in our trauma population. METHODS: Adult trauma patient screenings were performed by nursing staff during the triage process using the Columbia Suicide Severity Rating Scale, Clinical Practice Screener, Recent (C-SSRS)...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Aravind K Bommiasamy, Dayton Opel, Raluca McCallum, John D Yonge, Vicente Undurraga Perl, Christopher R Connelly, Darin Friess, Martin A Schreiber, Richard J Mullins
BACKGROUND: Traumatic hip dislocations (THD) are a medical emergency. There is debate whether the painful reduction of a dislocated hip should be first attempted using primary conscious sedation (PCS) or primary general anesthesia (PGA) METHODS: All cases of native THD from 2006 to 2015 in the trauma registry of a level 1 trauma center were reviewed. The primary outcome was successful reduction of the THD. RESULTS: 67 patients had a native, meaning not a hip prosthesis, THD...
February 27, 2018: American Journal of Surgery
L V Duggan, S L Lockhart, T M Cook, E P O'Sullivan, T Dare, P A Baker
In this exploratory study we describe the utility of smartphone technology for anonymous retrospective observational data collection of emergency front-of-neck airway management. The medical community continues to debate the optimal technique for emergency front-of-neck airway management. Although individual clinicians infrequently perform this procedure, hundreds are performed annually worldwide. Ubiquitous smartphone technology and internet connectivity have created the opportunity to collect these data. We created the 'Airway App', a smartphone application to capture the experiences of healthcare providers involved in emergency front-of-neck airway procedures...
March 13, 2018: Anaesthesia
L Bourgoin, L Caeymaex, F Decobert, C Jung, C Danan, X Durrmeyer
AIM: Less invasive surfactant administration (LISA) can avoid tracheal intubation for neonatal respiratory distress syndrome, but can be painful because it requires laryngoscopy. The aim of this study was to assess the efficacy and tolerance of intravenous atropine plus ketamine administration before LISA. METHODS: We conducted a prospective observational study of all premature infants hospitalised in our French neonatal intensive care unit treated with LISA between March 2015 and March 2016...
March 13, 2018: Acta Paediatrica
Jeffrey L Jarvis, John Gonzales, Danny Johns, Lauren Sager
STUDY OBJECTIVE: Peri-intubation hypoxia is an important adverse event of out-of-hospital rapid sequence intubation. The aim of this project is to determine whether a clinical bundle encompassing positioning, apneic oxygenation, delayed sequence intubation, and goal-directed preoxygenation is associated with decreased peri-intubation hypoxia compared with standard out-of-hospital rapid sequence intubation. METHODS: We conducted a retrospective, before-after study using data from a suburban emergency medical services (EMS) system in central Texas...
March 9, 2018: Annals of Emergency Medicine
Muhammad Irfan Farooque
Training in Emergency medicine for nearly 5 years, I thought the finish line was getting near and becoming a consultant was just down the corner. I was enjoying work, getting better every day and well appreciated by peers. But little did I know that life had other plans. I ended up in an emergency department presenting with status epilepticus preceded by vague ongoing symptoms lasting for 2 months. I was intubated and transferred to Intensive care and did not receive a formal diagnosis which still remains a mystery...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ray Coniglio, Constance McGraw, Mike Archuleta, Heather Bentler, Leigh Keiter, Julie Ramstetter, Elizabeth Reis, Cristi Romans, Rachael Schell, Kelli Ross, Rachel Smith, Jodi Townsend, Alessandro Orlando, Charles W Mains
Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Jose Melendez-Rosado, Juan E Corral, Sheetal Patel, Raul J Badillo, Dawn Francis
GOALS: The goal of this study is to examine the causes, type of adverse events (AE), and effects of elective intubation in outcomes associated with esophageal food impaction (EFI). BACKGROUND: EFI is a gastrointestinal emergency requiring immediate medical attention. STUDY: Retrospective review of all EFI cases presenting at 3 large tertiary centers from October 1, 2011 to October 31, 2014 and all cases registered in the Clinical Outcome Research Initiative (CORI) database from January 1, 2000 to December 31, 2012...
March 6, 2018: Journal of Clinical Gastroenterology
Mohamed R El-Tahan, Samah El Kenany, Ehsan M Abdelaty, Eiad A Ramzy
BACKGROUND: Preoperative remifentanil administration blunts haemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesised that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia. METHODS: Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomly allocated to receive remifentanil (0...
March 7, 2018: Minerva Anestesiologica
Takuya Onuki, Sho Ueda, Shinichi Otsu, Takahiro Yanagihara, Naoki Kawakami, Masatoshi Yamaoka, Masaharu Inagaki
A 34-year-old man was diagnosed with thymoma, which was evaluated preoperatively as stage II or III, with myasthenia gravis (MG). The size of the tumor was 70 × 44 × 80 mm. No invasion to neighboring organs was observed. Prednisolone was prescribed for stabilization of MG. However, a myasthenic crisis (MC) occurred, and intensive care, including emergent endobronchial intubation followed by artificial ventilation, pulse steroid therapy, high-dose intravenous immunoglobulin, and tacrolimus hydrate, was initiated...
March 7, 2018: Annals of Thoracic and Cardiovascular Surgery
Manuel F Struck, Johannes K M Fakler, Michael Bernhard, Thilo Busch, Patrick Stumpp, Gunther Hempel, André Beilicke, Sebastian N Stehr, Christoph Josten, Hermann Wrigge
This study aimes to determine the complication rates, possible risk factors and outcomes of emergency procedures performed during resuscitation of severely injured patients. The medical records of patients with an injury severity score (ISS) >15 admitted to the University Hospital Leipzig from 2010 to 2015 were reviewed. Within the first 24 hours of treatment, 526 patients had an overall mechanical complication rate of 26.2%. Multivariate analysis revealed out-of-hospital airway management (OR 3.140; 95% CI 1...
March 5, 2018: Scientific Reports
Timothy Johnson, Peter Richman, John R Allegra, Barnet Eskin, James Seger
BACKGROUND: Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65years old) patients in the emergency department (ED). OBJECTIVE: To determine if the percentage of elderly ED patients intubated has decreased in recent years. METHODS: Design: Retrospective multihospital cohort. SETTING: Consecutive ED patients in nine NJ hospitals (1/1/1999 to 9/30/2014)...
February 25, 2018: American Journal of Emergency Medicine
Yuko Shiima, Ting-Chang Hsieh, Andrew Long, Aaron Donoghue
OBJECTIVES: To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. DESIGN: Prospective observational study. SETTING: Emergency department resuscitation bay in single tertiary pediatric center. PATIENTS: Children undergoing emergent tracheal intubation under videorecorded conditions. INTERVENTIONS: None...
March 2018: Pediatric Critical Care Medicine
Stephanie Komura, Robert Rodriguez, Christopher R Peabody
BACKGROUND: Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used to prevent and treat various bleeding complications. In many studies, investigators have evaluated its utility and safety orally, intravenously, and topically, but few studies have described the potential benefits of nebulized TXA. CASE REPORT: We present a case of massive hemoptysis treated with nebulized TXA in the emergency department (ED) that led to the cessation of bleeding and avoidance of endotracheal intubation...
March 1, 2018: Journal of Emergency Medicine
Kamath Sriganesh, Jason W Busse, Harsha Shanthanna, Venkatapura J Ramesh
Background and Aims: There is a paucity of clinical practice guidelines for the ideal approach to airway management in patients with cervical spine instability (CSI). The aim of this survey was to evaluate preferences, perceptions and practices regarding airway management in patients with CSI among neuroanaesthesiologists practicing in India. Methods: A 25-item questionnaire was circulated for cross-sectional survey to 378 members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) by E-mail...
February 2018: Indian Journal of Anaesthesia
Robert P Jamplis, Lucas Friedman, Srikar Adhikari
A 28-year-old male was brought to the emergency department by the Emergency medical services (EMS) after being found unconscious and unresponsive. Upon arrival, he was hypotensive, intubated with a Glasgow Coma Scale (GCS) 3T, without the signs of trauma or the evidence of bleeding. A focused assessment with sonography in trauma (FAST), point-of-care ultrasound (POCUS) was performed, obscuring part of the spleen from the distended stomach, which was filled with the heterogeneous contents, with the internal movement being identified...
December 17, 2017: Curēus
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
Rebecca Maria Hasler, Sandra Stucky, Heinz Bähler, Aristomenis K Exadaktylos, Frank Neff
OBJECTIVE: Most deaths occur in the pre-hospital setting, whereas mortality in the emergency department (ED) is low (<1%). However, our clinical impression is that some patients are being transported to hospital in devastating conditions with no likelihood of survival, but demanding extensive hospital resources. The decision on whether to transport a dying person to hospital or not is a difficult task for emergency medical services (EMS) personnel. As there is little epidemiological data about these patients, this paper aims to describe this special population...
2018: PloS One
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