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Prehospital Airway

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https://www.readbyqxmd.com/read/29188917/-implementation-of-the-hartford-consensus-and-tactical-combat-casualty-care-recommendations-in-emergency-services-a-review-of-the-literature
#1
REVIEW
Carmen Usero-Pérez, Valentín González Alonso, Luis Orbañanos Peiro, José Manuel Gómez Crespo, Sheima Hossain López
Recent terrorist attacks involving active shooters or improvised explosive devices have shown that traditionally sequenced emergency management leads to delays in attending victims and suboptimal outcomes. Tactical medicine, a new concept in prehospital care, emerged from experience attending the wounded in combat zones, where the Tactical Combat Casualty Care (TCCC) recommendations are applied. TCCC targets 3 main causes of preventable death in combat: bleeding from extremities, tension pneumothorax, and airway obstruction...
2017: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29175355/an-assessment-of-ventilation-and-perfusion-markers-in-out-of-hospital-cardiac-arrest-patients-receiving-mechanical-cpr-with-endotracheal-or-supraglottic-airways
#2
Torben K Becker, Aric W Berning, Arjun Prabhu, Clifton W Callaway, Francis X Guyette, Christian Martin-Gill
AIM OF THE STUDY: Mechanical chest compression (MCPR) devices are considered equivalent to manual compressions in patient outcomes in out-of-hospital cardiac arrest (OHCA). However, recent data suggest possible harm in patients with a supraglottic airway device (SGA) during MCPR. The aim of this study was to evaluate differences in direct and indirect markers of ventilation and perfusion in patients with cardiac arrest receiving MCPR and who had their airway managed with an endotracheal tube (ETT) or SGA...
November 23, 2017: Resuscitation
https://www.readbyqxmd.com/read/29143074/-additional-emergency-medical-measures-in-trauma-associated-cardiac-arrest
#3
B Ondruschka, C Baier, J Dreßler, A Höch, M Bernhard, C Kleber, C Buschmann
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases...
November 15, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29109872/severe-decompression-illness-case-report-prehospital-recognition-and-regional-transport-considerations
#4
Julie Estrada, David Meurer, Kevin De Boer, Karl Huesgen
A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29096887/definitive-airway-management-after-prehospital-supraglottic-rescue-airway-in-pediatric-trauma
#5
Matthew C Hernandez, Ryan M Antiel, Karthik Balakrishnan, Martin D Zielinski, Denise B Klinkner
INTRODUCTION: Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). METHODS: We reviewed pediatric multisystem trauma patients (2005-2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS). RESULTS: Ninety patients were included (SGA, n=17 and BVM, n=73)...
October 6, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28927951/definitive-airway-management-after-pre-hospital-supraglottic-airway-insertion-outcomes-and-a-management-algorithm-for-trauma-patients
#6
Matthew C Hernandez, Johnathon M Aho, Martin D Zielinski, Scott P Zietlow, Brian D Kim, David S Morris
BACKGROUND: Prehospital airway management increasingly involves supraglottic airway insertion and a paucity of data evaluates outcomes in trauma populations. We aim to describe definitive airway management in traumatically injured patients who necessitated prehospital supraglottic airway insertion. METHODS: We performed a single institution retrospective review of multisystem injured patients (≥15years) that received prehospital supraglottic airway insertion during 2009 to 2016...
September 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28915898/physician-staffed-helicopter-emergency-medical-service-has-a-beneficial-impact-on-the-incidence-of-prehospital-hypoxia-and-secured-airways-on-patients-with-severe-traumatic-brain-injury
#7
Toni Pakkanen, Antti Kämäräinen, Heini Huhtala, Tom Silfvast, Jouni Nurmi, Ilkka Virkkunen, Arvi Yli-Hankala
BACKGROUND: After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients. METHODS: This was a retrospective cohort study...
September 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28910462/prehospital-cricothyrotomy-kits-used-in-combat
#8
Steven G Schauer, Michael D April, Cord W Cunningham, Adrianna N Long, Robert Carter
BACKGROUND: Surgical cricothyrotomy remains the only definitive airway management modality for the tactical setting recommended by Tactical Combat Casualty Care guidelines. Some units have fielded commercial cricothyrotomy kits to assist Combat Medics with surgical cricothyrotomy. To our knowledge, no previous publications report data on the use of these kits in combat settings. This series reports the the use of two kits in four patients in the prehospital combat setting. METHODS: Using the Department of Defense Trauma Registry and the Prehospital Trauma Registry, we identified four cases of patients who underwent prehospital cricothyrotomy with the use of commercial kits...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28857641/safety-events-in-high-risk-prehospital-neonatal-calls
#9
Rebecca Duby, Matt Hansen, Garth Meckler, Barbara Skarica, William Lambert, Jeanne-Marie Guise
OBJECTIVE: The objective of this study was to quantify and characterize patient safety events during high-risk neonatal transports in the prehospital setting. METHOD: We conducted a retrospective chart review of all "lights and sirens" ambulance transports of neonates ≤30 days old over a four-year period in a metropolitan area. Each case was independently reviewed for potential patient safety events that may have occurred in clinical assessment and decision making, resuscitation, airway management, fluid or medication administration, procedures performed, and/or equipment used...
August 31, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28833853/the-pediatric-submersion-score-predicts-children-at-low-risk-for-injury-following-submersions
#10
Rohit P Shenoi, Sachin Allahabadi, Daniel M Rubalcava, Elizabeth A Camp
OBJECTIVES: Pediatric submersion victims often require admission. We wanted to identify a cohort of children at low risk for submersion-related injury who can be safely discharged from the emergency department (ED) after a period of observation. METHODS: This was a single-center retrospective derivation/validation cross-sectional study of children (0-18 years) who presented postsubmersion to a tertiary care, children's hospital ED from 2008 to 2015. We reviewed demographics, comorbidities, and prehospital and ED course...
August 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28807071/single-rescuer-ventilation-using-a-bag-valve-mask-with-removable-external-handle-a-randomized-crossover-trial
#11
Paul Reed, Baruch Zobrist, Monica Casmaer, Steven G Schauer, Nurani Kester, Michael D April
Introduction Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting. Hypothesis Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model. METHODS: This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark)...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28750882/unrecognized-failed-airway-management-using-a-supraglottic-airway-device
#12
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/28701849/blunt-trauma-neck-with-complete-tracheal-transection-a-diagnostic-and-therapeutic-challenge-to-the-trauma-team
#13
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/28698134/effects-of-advanced-life-support-on-patients-who-suffered-cardiac-arrest-outside-of-hospital-and-were-defibrillated
#14
Akihito Hagihara, Daisuke Onozuka, Takashi Nagata, Manabu Hasegawa
BACKGROUND: The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. METHODS: This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed...
July 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28669372/observational-study-on-safety-of-prehospital-bls-cpap-in-dyspnea
#15
Novneet Sahu, Patrick Matthews, Kathryn Groner, Mia A Papas, Ross Megargel
Introduction Continuous positive airway pressure (CPAP) improves outcomes in patients with respiratory distress. Additional benefits are seen with CPAP application in the prehospital setting. Theoretical safety concerns regarding Basic Life Support (BLS) providers using CPAP exist. In Delaware's (USA) two-tiered Emergency Medical Service (EMS) system, BLS often arrives before Advanced Life Support (ALS). Hypothesis This study fills a gap in literature by evaluating the safety of CPAP applied by BLS prior to ALS arrival...
July 3, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28616613/comparison-of-the-airway-access-skills-of-prehospital-staff-in-moving-and-stationary-ambulance-simulation-a-randomized-crossover-study
#16
Onur Karaca, Basak Bayram, Nese Colak Oray, Asli Acerer, Zeynep Sofuoglu
OBJECTIVES: We aimed to compare the procedural success and intervention durations regarding various airway access skills in moving and stationary ambulance simulations. MATERIAL AND METHODS: An ambulance simulator was used to simulate the moving ambulance environment, and a standard manikin was used for airway simulation. The study included 38 paramedics and paramedic students. In stationary and moving environments, a classical endotracheal intubation with a stylet, an intubation with a gum elastic bougie (GEB), a laryngeal mask airway (LMA), and a laryngeal tube (LT) were applied randomly...
June 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28615900/predictors-of-outcome-in-children-with-status-epilepticus-during-resuscitation-in-pediatric-emergency-department-a-retrospective-observational-study
#17
Indumathy Santhanam, Sangeetha Yoganathan, V Akila Sivakumar, Rubini Ramakrishnamurugan, Sharada Sathish, Murali Thandavarayan
OBJECTIVES: To study the clinical profile and predictors of outcome in children with status epilepticus (SE) during resuscitation in pediatric emergency department. MATERIALS AND METHODS: This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD), and subtle SE until all parameters resolved...
April 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28611887/derivation-and-validation-of-the-prehospital-difficult-airway-identificationtool-predait-a-predictive-model-for-difficult-intubation
#18
Jestin N Carlson, David Hostler, Francis X Guyette, Mark Pinchalk, Christian Martin-Gill
INTRODUCTION: Endotracheal intubation (ETI) in the prehospital setting poses unique challenges where multiple ETI attempts are associated with adverse patient outcomes. Early identification of difficult ETI cases will allow providers to tailor airway-management efforts to minimize complications associated with ETI. We sought to derive and validate a prehospital difficult airway identification tool based on predictors of difficult ETI in other settings. METHODS: We prospectively collected patient and airway data on all airway attempts from 16 Advanced Life Support (ALS) ground emergency medical services (EMS) agencies from January 2011 to October 2014...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28601212/awake-cricothyrotomy-a-novel-approach-to-the-surgical-airway-in-the-tactical-setting
#19
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/28599052/tccc-updates-two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#20
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of bestpractice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the US Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
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