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Emergency Intubation

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https://www.readbyqxmd.com/read/28934985/factors-influencing-on-scene-time-in-a-rural-norwegian-helicopter-emergency-medical-service-a-retrospective-observational-study
#1
Øyvind Østerås, Jon-Kenneth Heltne, Bjørn-Christian Vikenes, Jörg Assmus, Guttorm Brattebø
BACKGROUND: Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions...
September 21, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28932302/predictive-value-of-tracheal-rapid-ultrasound-exam-performed-in-the-emergency-department-for-verification-of-tracheal-intubation
#2
Babak Masoumi, Reza Azizkhani, Gilava Hedayati Emam, Morteza Asgarzadeh, Behrouz Zargar Kharazi
BACKGROUND: Verification of the correct placement of the endotracheal tube (ETT) has been one of the most challenging issues of airway management in the field of emergency medicine. Early detection of oesophagal intubation through a reliable method is important for emergency physicians. AIM: The aim of this study was to assess the diagnostic accuracy of tracheal rapid ultrasound exam (TRUE) to assess endotracheal tube misplacement during emergency intubation. METHODS: This was an observational prospective study performed in the emergency department of the major tertiary referral hospital in the city...
August 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28930950/increased-mortality-in-trauma-patients-who-develop-postintubation-hypotension
#3
Robert S Green, Michael B Butler, Mete Erdogan
BACKGROUND: Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in trauma patients and assess the association of PIH with patient outcomes. METHODS: Retrospective case series of adult (≥16 years) patients who were intubated on arrival at a tertiary trauma center in Halifax, Nova Scotia, Canada, between 2000 and 2015...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28927394/laboratory-markers-of-cardiac-and-metabolic-complications-after-generalized-tonic-clonic-seizures
#4
Robert D Nass, Sina Meiling, René P Andrié, Christian E Elger, Rainer Surges
BACKGROUND: Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS. METHODS: We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015...
September 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28920564/intentional-overdose-of-the-novel-anti-epileptic-drug-eslicarbazepine-presenting-with-recurrent-seizures-and-ventricular-dysrhythmias
#5
Jesse Thompson, James D Powell, Daniel H Ovakim
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation...
September 18, 2017: CJEM
https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#6
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
September 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28917437/effects-of-intravenous-administration-of-fentanyl-and-lidocaine-on-hemodynamic-responses-following-endotracheal-intubation
#7
Amir Masoud Hashemian, Hamid Zamani Moghadam Doloo, Maziar Saadatfar, Roya Moallem, Maryam Moradifar, Raheleh Faramarzi, Mohammad Davood Sharifi
OBJECTIVES: To compare the effects of intravenous fentanyl and lidocaine on hemodynamic changes following endotracheal intubation in patients requiring Rapid Sequence Intubation (RSI) in the emergency department (ED). METHODS: A single-centered, prospective, simple non-randomized, double-blind clinical trial was conducted on 96 patients who needed RSI in Edalatian ED. They were randomly divided into three groups (fentanyl group (F), lidocaine group (L), and fentanyl plus lidocaine (M) as our control group)...
July 21, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#8
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28913751/emergency-neurological-life-support-airway-ventilation-and-sedation
#9
Venkatakrishna Rajajee, Becky Riggs, David B Seder
Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, Airway, Ventilation, and Sedation was chosen as an Emergency Neurological Life Support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings and the use of sedative agents based on the patient's neurological status...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913501/acute-poisoning-due-to-ingestion-of-datura-stramonium-a-case-report
#10
Sebastian Daniel Trancă, Robert Szabo, Mihaela Cociş
Datura stramonium (DS) is a widespread annual plant, containing atropine, hyoscyamine, and scopolamine, which can produce poisoning with a severe anticholinergic syndrome. Teenagers ingest the roots, seeds or the entire plant to obtain its hallucinogenic and euphoric effects. We presented the case of a 22 year old male who was admitted to the Emergency Room in a coma after consuming Datura stramonium, 2 hours earlier. The patient presented with fever, tachycardia with right bundle branch block, and urinary retention...
April 2017: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28905656/comparison-of-low-dose-and-standard-dose-abdominal-ct-scan-in-body-stuffers
#11
Hooman Bahrami-Motlagh, Zahra Mahboubi-Fooladi, Babak Salevatipour, Hossein Hassanian-Moghaddam, Seyyed Hadi Mirhashemi
PURPOSE: Detection of body stuffers is challenging in emergency departments. Because of the small size of baggies, plain radiograph is of little value in most suspects. On the other hand, abdomen CT scan is burdened by high cost and radiation dose. This study was performed to compare the image quality, radiation dose and accuracy of low-dose CT scan in comparison with standard dose. MATERIAL AND METHODS: In this prospective study, suspected body stuffers who were referred to the radiology department underwent two different protocols of abdominal non-contrast CT scan simultaneously: low-dose (with equivalent dose to conventional abdominal x-ray) and standard dose...
September 14, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28905252/human-and-equipment-resources-for-difficult-airway-management-airway-education-programs-and-capnometry-use-in-japanese-emergency-departments-a-nationwide-cross-sectional-study
#12
Yuko Ono, Koichi Tanigawa, Kazuaki Shinohara, Tetsuhiro Yano, Kotaro Sorimachi, Ryota Inokuchi, Jiro Shimada
BACKGROUND: Although human and equipment resources, proper training, and the verification of endotracheal intubation are vital elements of difficult airway management (DAM), their availability in Japanese emergency departments (EDs) has not been determined. How ED type and patient volume affect DAM preparation is also unclear. We conducted the present survey to address this knowledge gaps. METHODS: This nationwide cross-sectional study was conducted from April to September 2016...
September 13, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28904980/enterovirus-human-rhinovirus-a-rare-cause-of-acute-respiratory-distress-syndrome
#13
Parita Soni, Anand Rai, Nidhi Aggarwal, Stephan Kamholz, Taek Yoon, Yizhak Kupfer
A 22-year-old Asian woman presented with respiratory distress, cough, and wheezing for 1 week. Prior history included asthma and Turner syndrome. On presentation to the emergency department, the patient was hypotensive, tachycardic, tachypneic, with an oxyhemoglobin saturation in the mid 80% range while breathing ambient air. Chest radiograph revealed pulmonary vascular congestion and a left lower lobe infiltrate. Endotracheal intubation, mechanical ventilation, and vasopressors were initiated. Empiric therapy for community-acquired pneumonia was administered utilizing broad-spectrum intravenous antibiotics...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28898557/improved-survival-for-rural-trauma-patients-transported-by-helicopter-to-a-verified-trauma-center-a-propensity-score-analysis
#14
Thein Hlaing Zhu, Lisa Hollister, Dazar Opoku, Samuel M Galvagno
OBJECTIVES: Recent studies using advanced statistical methods to control for confounders have demonstrated an association between helicopter transport (HT) vs. ground ambulance transport (GT) in terms of improved survival for adult trauma patients. The aim of this study was to apply a methodologically vigorous approach to determine if HT is associated with a survival benefit for when trauma patients are transported to a verified trauma center in a rural setting. METHODS: The ascertainment of trauma patients age ≥15 years (n=469 cases) by HT and (n=580 cases) by GT between 1999 and 2012 was restricted to the scene of injury in a rural area of 10 to 35 miles from the trauma center...
September 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28889210/ketamine-and-midazolam-differently-impact-post-intubation-hemodynamic-profile-when-used-as-induction-agents-during-emergency-airway-management-in-hemodynamically-stable-patients-with-st-elevation-myocardial-infarction
#15
Marco Zuin, Gianluca Rigatelli, Fabio Dell'Avvocata, Giuseppe Faggian, Luca Conte, Sara Giatti, Flavio Michielan, Loris Roncon
We investigated the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI) and medicated with ketamine or midazolam as induction agent. STEMI patients admitted between 1st January 2009 and 1st January 2017 who did not receive any type of inotropic support before the endotracheal intubation (ETI) was reviewed. PIH was defined as a reduction greater than 20% or a drop of systolic blood pressure (SBP) below 90 mmHg within 10 min from the administration of the induction agent [ketamine (1 mg/kg) or midazolam (0...
September 9, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28888560/unintentional-cannabis-ingestion-in-children-a-systematic-review
#16
John R Richards, Nishelle E Smith, Aimee K Moulin
OBJECTIVE: To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome. STUDY DESIGN: PubMed, OpenGrey, and Google Scholar were systematically searched. Articles were selected, reviewed, and graded using Oxford Center for Evidence-Based Medicine guidelines. RESULTS: Of 3316 articles, 44 were included (3582 children age ≤12 years). We found no high quality (Oxford Center for Evidence-Based Medicine level I or II) studies and 10 level III studies documenting lethargy as the most common presenting sign and confirming increasing incidence of unintentional ingestion in states having decriminalized medical and recreational cannabis...
September 6, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28882637/successful-retrograde-intubation-after-failed-fiberoptic-intubation-and-percutaneous-cricothyrotomy
#17
Stephanie Brenman, Sachin Gupta, Stephanie Tseeng
BACKGROUND: An obstructive neck lesion presents an airway challenge for any emergency physician. Retrograde intubation is an infrequently used airway alternative that can be employed in the difficult airway algorithm that requires little training and is less invasive than surgical cricothyrotomy. CASE REPORT: We report a case of a 31-year-old male patient who presented with respiratory distress progressing to respiratory failure from upper airway obstruction. The patient had significant tracheal thickening at the level of the thyroid gland based on a computed tomography report from 3 weeks prior to his presentation...
September 4, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28879341/airway-obstruction-by-dissection-of-the-inner-layer-of-a-reinforced-endotracheal-tube-in-a-patient-with-ludwig-s-angina-a-case-report
#18
Sung-Min Shim, Jae-Ho Park, Dong-Min Hyun, Hwa-Mi Lee
Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl (100 µg), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to 38 cmH2O and plateau pressure increased from 20 to 28 cmH2O...
June 2017: J Dent Anesth Pain Med
https://www.readbyqxmd.com/read/28874952/duration-of-mechanical-ventilation-in-the-emergency-department
#19
Lauren B Angotti, Jeremy B Richards, Daniel F Fisher, Jeffrey D Sankoff, Todd A Seigel, Haitham S Al Ashry, Susan R Wilcox
INTRODUCTION: Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS). METHODS: This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874303/airway-management-in-an-infant-with-a-large-supraglottic-mass-after-failed-fiberoptic-intubation
#20
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
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