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Cricothyrotomy

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https://www.readbyqxmd.com/read/28686377/-airways-access-in-cannot-intubate-situation-cricothyrotomy
#1
Frédéric Heymans, Pavel Dulguerov
In case of impossible intubation /oxygenation because of an upper airways obstruction, a cricothyrotomy is indicated. It is a relative simple and safe procedure that may be life saving. A blade, a tube and one's index finger are the only tools needed. The procedure can be done anywhere and every physician should be able to perform it. Several devices have been developed to try to improve it's success rate ; on the contrary, they render the task more complicated and lead to double failure rates with associated lesions, as described in our comparative study...
October 5, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28601212/awake-cricothyrotomy-a-novel-approach-to-the-surgical-airway-in-the-tactical-setting
#2
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/28599040/intubation-of-the-right-atrium-during-an-attempted-modified-surgical-airway-in-a-pig
#3
Jason Bowman, Andrew Juergens, Matthew McClure, Dave Spear
In modern medicine, the surgical cricothyrotomy is an airway procedure of last resort. In austere environments, however, its simplicity may make it a more feasible option than carrying a full complement of laryngoscopes. To create a Transportation Security Agency-compliant compact first-response bag, we attempted to establish a surgical cricothyrotomy in a pig, using trauma shears, basic medical scissors, a pocket bougie, and an endotracheal tube. Bougies can provide tactile feedback via the "tracheal ring sign" and "stop sign" to indicate positive tracheal placement during orotracheal intubation...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28463474/the-height-of-the-cricothyroid-membrane-on-computed-tomography-scans-in-trauma-patients
#4
T Nutbeam, R Clarke, T Luff, D Enki, D Gay
Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a 'can't intubate, can't oxygenate' scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population...
May 2, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28460647/-cannot-ventilate-cannot-intubate-situation-after-penetration-of-the-tongue-root-through-to-the-epipharynx-by-a-surfboard-a-case-report
#5
Yuko Ono, Miha Kunii, Tomohiro Miura, Kazuaki Shinohara
BACKGROUND: Surfing is an increasingly popular activity and surfing-related injuries have increased accordingly. However, to the best of our knowledge, there are no reports of penetrating upper airway injuries in surfers. We present a "cannot ventilate, cannot intubate" situation following penetrating neck injury by a surfboard fin. CASE PRESENTATION: A previously healthy 29-year-old Japanese man was swept off his board by a large wave and his left mandible, tongue root, and right epipharynx were penetrated by the surfboard fin...
May 1, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28273224/emergency-cricothyrotomy-temporary-measure-or-definitive-airway-a-systematic-review
#6
Marina Barguil Macêdo, Ruggeri Bezerra Guimarães, Sahâmia Martins Ribeiro, Kátia Maria Marabuco DE Sousa
Being a fast and safe method in the hands of well trained professionals in both prehospital and intrahospital care, Cricothyrotomy has been broadly recommended as the initial surgical airway in the scenario "can't intubate, can't ventilate", and is particularly useful when the obstruction level is above or at the glottis. Its prolonged permanence, however, is an endless source of controversy. In this review we evaluate the complications of cricothyrotomy and the need of its routine conversion to tracheotomy through a search on PubMed, LILACS and SciELO electronic databases with no restriction to the year or language of the publication...
December 2016: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28110989/emergency-department-airway-management-of%C3%A2-severe-angioedema-a-video-review-of-45%C3%A2-intubations
#7
Brian E Driver, John W McGill
STUDY OBJECTIVE: Angioedema is an uncommon but important cause of airway obstruction. Emergency airway management of angioedema is difficult. We seek to describe the course and outcomes of emergency airway management for severe angioedema in our institution. METHODS: We performed a retrospective, observational study of all intubations for angioedema performed in an urban academic emergency department (ED) between November 2007 and June 2015. We performed a structured review of video recordings of each intubation...
May 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27785883/systematic-review-and-meta-analysis-of-first-pass-success-rates-in-emergency-department-intubation-creating-a-benchmark-for-emergency-airway-care
#8
Louise Park, Irene Zeng, Andrew Brainard
OBJECTIVE: Many EDs have begun to evaluate their airway performance. The first-pass success (FPS) rate is a commonly used marker of proficiency, and has been associated with rates of adverse events. The aim of this systematic review and meta-analysis is to quantify the ED FPS rates and summarise the rates of adverse events associated with endotracheal intubation. METHODS: A structured literature search was performed through MEDLINE and EMBASE. Research published since 2000 was included if it prospectively collected data on all patients intubated in the ED and reported the FPS rates...
February 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27769777/improvised-cricothyrotomy-on-a-mountain-using-hiking-gear
#9
Clare A Johnson, Diana S Goodwine, Ingrid Passier
We present a case of a 57-year-old man who fell while climbing a mountain in California and sustained severe facial trauma. Three firefighters and 2 emergency physicians witnessed the fall and resuscitated the patient. The patient ultimately required a surgical cricothyrotomy performed with a pocket knife and Platypus hydration pack. The physicians made a makeshift positive pressure airway device using the Platypus hydration pack. We believe this is the first case report describing an improvised cricothyrotomy performed in the wilderness using only hiking gear...
December 2016: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/27669029/anesthetic-management-for-pediatric-awake-tracheostomy
#10
Ian Yuan, Benjamin B Bruins, Eleanor P Kiell, Luv R Javia, Jorge A Galvez
Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.
December 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27607408/impaired-ventilation-and-oxygenation-after-emergency-cricothyrotomy-recommendations-for-the-management-of-suboptimal-invasive-airway-access
#11
Matthew A Warner, Hugh M Smith, Martin D Zielinski
Invasive airway access by emergent cricothyrotomy remains an essential treatment modality in "can't intubate/can't ventilate" scenarios. Although numerous commercial devices are available, limited comparative data exist with regard to the ventilation and oxygenation parameters of these devices. We report a case of severely compromised respiratory function while using the Quicktrach II, a commercially available emergency cricothyrotomy device. Because of oxygenation and ventilatory insufficiency, our patient required emergent removal of the device and surgical tracheostomy to improve respiratory function...
November 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27555619/compensating-artificial-airway-resistance-via-active-expiration-assistance
#12
Steffen Wirth, Luc Seywert, Johannes Spaeth, Stefan Schumann
BACKGROUND: Artificial airway resistance as provided by small-lumen tracheal tubes or catheters increases the risk of intrinsic PEEP (PEEPi). We hypothesized that by active expiration assistance, larger minute volumes could be generated without causing PEEPi compared with conventional mechanical ventilation when using small-lumen tracheal tubes or a cricothyrotomy catheter. METHODS: We investigated the active expiration assistance in a physical model of the respiratory system and estimated its hypothetical performance in terms of maximal flow generated with endotracheal tubes ranging from 3...
December 2016: Respiratory Care
https://www.readbyqxmd.com/read/27450602/literature-evidence-on-live-animal-versus-synthetic-models-for-training-and-assessing-trauma-resuscitation-procedures
#13
REVIEW
Danielle Hart, Mary Ann McNeil, Cullen Hegarty, Robert Rush, Jeffery Chipman, Joseph Clinton, Troy Reihsen, Robert Sweet
There are many models currently used for teaching and assessing performance of trauma-related airway, breathing, and hemorrhage procedures. Although many programs use live animal (live tissue [LT]) models, there is a congressional effort to transition to the use of nonanimal- based methods (i.e., simulators, cadavers) for military trainees. We examined the existing literature and compared the efficacy, acceptability, and validity of available models with a focus on comparing LT models with synthetic systems...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27437121/situational-analysis-of-essential-surgical-care-management-in-iran-using-the-who-tool
#14
Rohollah Kalhor, Nastaran Keshavarz Mohamadi, Nader Khalesi, Mehdi Jafari
BACKGROUND: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. OBJECTIVES: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. MATERIALS AND METHODS: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure...
May 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/27432055/ultrasonographic-identification-of-the-cricothyroid-membrane-best-evidence-techniques-and-clinical-impact
#15
M S Kristensen, W H Teoh, S S Rudolph
Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review summarizes the current evidence for application of airway ultrasonography for identification of the cricothyroid membrane compared with the clinical techniques. We identified the best-documented techniques for bedside use, their success rates, and the necessary training for airway-ultrasound-naïve clinicians. After a short but structured training, the cricothyroid membrane can be identified using ultrasound in difficult patients by previously airway-ultrasound naïve anaesthetists with double the success rate of palpation...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27425433/teaching-advanced-trauma-life-support-atls-a-nationwide-retrospective-analysis-of-8202-lessons-taught-in-germany
#16
Markus M Luedi, Christoph C Wölfl, Katharina Wieferich, Agron Dogjani, Peter Kauf, Dietrich Doll
OBJECTIVE: To examine whether faculty who teach the Advanced Trauma Life Support (ATLS) course would improve with experience and, correspondingly, ratings from course evaluations would increase. DESIGN: Retrospective analysis of student evaluations of 262 ATLS courses held between 2008 and 2012. SETTING: All ATLS courses held between 2008 and 2012 nationwide in Germany. PARTICIPANTS: All ATLS student course evaluations covering 8202 lessons, 81 instructors, 36 course directors, and 5 coordinators...
January 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/27330674/out-of-hospital-surgical-airway-management-does-scope-of-practice-equal-actual-practice
#17
Molly Furin, Melissa Kohn, Ryan Overberger, David Jaslow
INTRODUCTION: Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy. METHODS: Eighty-six paramedics employed by four ground emergency medical services agencies completed a 22-question written survey that assessed surgical airway attempts, training, skills verification, and perceptions about procedural competency...
May 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27315316/expanding-hematoma-s-life-threatening-neck-and-face-emergency-management-of-ballistic-injuries
#18
Sabri T Shuker
This article aims to bring attention to the morbidity and fatality of hemorrhage, how expanding hematoma and air compromise neck/face N/F injuries and present challenges. Large neck vessel ballistic injuries may lead to hemorrhage and expanding hematoma, resulting in airway compromise, due to injuries to the internal and/or external carotid arteries, internal jugular veins "internal carotid artery, external carotid artery, internal jugular vein," and the external carotid artery deep branches. This also leads to injuries to the cervical fascial layers (barriers of deep spaces) that facilitate pooling blood and hematoma into compartmental and large potential space which effects the pharynx, larynx, esophagus, and trachea...
July 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27281093/safairway-an-airway-training-for-pulmonologists-performing-a-flexible-bronchoscopy-with-nonanesthesiologist-administered-propofol-sedation-a-prospective-evaluation
#19
Melanie Schulze, Bastian Grande, Michaela Kolbe, Sarah Kriech, Christoph B Nöthiger, Malcolm Kohler, Donat R Spahn, Daniel Franzen
Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27275670/surgical-cricothyrotomy-rather-than-percutaneous-cricothyrotomy-in-cannot-intubate-cannot-oxygenate-situation
#20
Takashi Asai
No abstract text is available yet for this article.
August 2016: Anesthesiology
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