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"rapid Sequence"

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
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
Kimihiro Nakamura, Michiru Makuuchi, Tatsuhide Oga, Tomomi Mizuochi-Endo, Toshiki Iwabuchi, Yasoichi Nakajima, Stanislas Dehaene
A growing body of neuroimaging data suggests that direct measurements of brain activity can reveal subliminal effects that remain invisible with behavior measures alone. We examined whether sentence comprehension processes could be triggered by a sequence of masked words. On each trial, participants viewed a rapid sequence of masked or unmasked words, including a subject noun, three adverbs and followed by a visible target verb. To probe the capacity limits of unconscious processing, we measured event-related potentials associated with the semantic congruency between the noun and the verb, while varying the subject position in each sentence...
March 7, 2018: European Journal of Neuroscience
T Mencke, A Zitzmann, D A Reuter
Rapid sequence induction (RSI) is a specific technique for anesthesia induction, which is performed in patients with an increased risk for pulmonary aspiration (e.g. intestinal obstruction, severe injuries and cesarean section). The incidence of acute respiratory distress syndrome (ARDS) is very low but 10-30% of anesthesia-related deaths are caused by the consequences of ARDS. The classical RSI with its main components (i.e. head-up position, avoidance of positive pressure ventilation and administration of succinylcholine) was published nearly 50 years ago and has remained almost unchanged...
March 5, 2018: Der Anaesthesist
Brian C Grubel, Bryan T Bosworth, Michael R Kossey, A Brinton Cooper, Mark A Foster, Amy C Foster
We present a secure communication system constructed using pairs of nonlinear photonic physical unclonable functions (PUFs) that harness physical chaos in integrated silicon micro-cavities. Compared to a large, electronically stored one-time pad, our method provisions large amounts of information within the intrinsically complex nanostructure of the micro-cavities. By probing a micro-cavity with a rapid sequence of spectrally-encoded ultrafast optical pulses and measuring the lightwave responses, we experimentally demonstrate the ability to extract 2...
February 19, 2018: Optics Express
David J Olvera, David F E Stuhlmiller, Allen Wolfe, Charles F Swearingen, Troy Pennington, Daniel P Davis
INTRODUCTION: Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. OBJECTIVES: The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success...
February 21, 2018: Prehospital Emergency Care
Stefan Heschl, Ben Meadley, Emily Andrew, Warwick Butt, Stephen Bernard, Karen Smith
INTRODUCTION: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation...
February 12, 2018: Injury
Dhara P Amin, Michael N Cooper, Kim I Newton
BACKGROUND: Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction. CASE REPORT: Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously undiagnosed thrombocytopenia...
February 13, 2018: Journal of Emergency Medicine
Joshua T Bucher, Christopher Bryczkowski, Grant Wei, Renee L Riggs, Anoop Kotwal, Brian Sumner, Jonathan V McCoy
BACKGROUND: The purpose of our study is to investigate rates of individual procedures performed by residents in our emergency medicine (EM) residency program. Different programs expose residents to different training environments. Our hypothesis is that ultrasound examinations are the most commonly performed procedure in our residency. METHODS: The study took place in an academic level I trauma center with multiple residency and fellowship programs including surgery, surgical critical care, trauma, medicine, pulmonary/critical care, anesthesiology and others...
February 14, 2018: International Journal of Emergency Medicine
Christine M Groth, Nicole M Acquisto, Tina Khadem
PURPOSE: Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events. MATERIALS AND METHODS: This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation. RESULTS: A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%)...
January 30, 2018: Journal of Critical Care
A Higgs, B A McGrath, C Goddard, J Rangasami, G Suntharalingam, R Gale, T M Cook
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not...
February 2018: British Journal of Anaesthesia
Ashleigh Delorenzo, Toby St Clair, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia...
February 6, 2018: Prehospital Emergency Care
Pieter F Fouche, Christopher Stein, Paul Simpson, Jestin N Carlson, Kristina M Zverinova, Suhail A Doi
INTRODUCTION: Endotracheal intubation (ETI) is a critical procedure performed by both air medical and ground based emergency medical services (EMS). Previous work has suggested that ETI success rates are greater for air medical providers. However, air medical providers may have greater airway experience, enhanced airway education, and access to alternative ETI options such as rapid sequence intubation (RSI). We sought to analyze the impact of the type of EMS on RSI success. METHODS: A systematic literature search of Medline, Embase, and the Cochrane Library was conducted and eligibility, data extraction, and assessment of risk of bias were assessed independently by two reviewers...
January 29, 2018: Prehospital Emergency Care
Santi Maurizio Raineri, Andrea Cortegiani, Giuseppe Accurso, Claudia Procaccianti, Filippo Vitale, Sabrina Caruso, Antonino Giarratano, Cesare Gregoretti
Objective: To assess the efficacy and safety of high-flow nasal oxygen (HFNO) therapy in patients undergoing rapid sequence intubation (RSI) for emergency abdominal surgery. Methods: HFNO of 60 L.min-1 at an inspiratory oxygen fraction of 1 was delivered 4 min before laryngoscopy and maintained until the patient was intubated, and correct intubation was verified by the appearance of the end-tidal CO2 (EtCO2) waveform. Transcutaneous oxygenation (SpO2), heart rate and non-invasive mean arterial pressure were monitored at baseline (T0), after 4 min on HFNO (T1) and at the time of laryngoscopy (T2) and endotracheal intubation (ETI) (T3)...
December 2017: Turkish Journal of Anaesthesiology and Reanimation
Henry E Wang, John P Donnelly, Dustin Barton, Jeffrey L Jarvis
STUDY OBJECTIVE: Although often the focus of quality improvement efforts, emergency medical services (EMS) advanced airway management performance has few national comparisons, nor are there many assessments with benchmarks accounting for differences in agency volume or patient mix. We seek to assess variations in advanced airway management and conventional intubation performance in a national cohort of EMS agencies. METHODS: We used EMS data from ESO Solutions, a national EMS electronic health record system...
January 15, 2018: Annals of Emergency Medicine
Edward Kuzmack, Travis Inglis, David Olvera, Allen Wolfe, Kona Seng, Daniel Davis
BACKGROUND: Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. OBJECTIVE: To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort...
January 10, 2018: Journal of Emergency Medicine
Å Lodenius, J Piehl, A Östlund, J Ullman, M Jonsson Fagerlund
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in rapid sequence induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing rapid sequence induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE...
January 13, 2018: Anaesthesia
S Ångerman, H Kirves, J Nurmi
Results using videolaryngoscopy in pre-hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first-pass tracheal intubation success rate. We employed videolaryngoscopy (C-MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist-staffed helicopter emergency medical service...
January 8, 2018: Anaesthesia
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
January 3, 2018: Prehospital Emergency Care
Jinguo Wang, Na Wang, Wei Han, Zhanyang Han
The objective of this study is to describe the anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) syndrome and renal insufficiency. A 28-year-old female patient, gestational age of 35 weeks, with hypertensive crisis (blood pressure 190/110 mmHg), was admitted for an emergency cesarean section after diagnosis of HELLP syndrome and renal insufficiency. We performed total intravenous general anesthesia with rapid sequence induction. During the surgical procedure, reduced urine output and coagulopathy were detected...
October 2017: Anesthesia, Essays and Researches
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