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https://www.readbyqxmd.com/read/29162438/peri-intubation-factors-affecting-emergency-physician-choice-of-paralytic-agent-for-rapid-sequence-intubation-of-trauma-patients
#1
Jason R West, Catherine Lott, Lee Donner, Marc Kanter, Nicholas D Caputo
INTRODUCTION: No study has assessed predictors of physician choice between the succinylcholine (Succ) and rocuronium (Roc) for rapid sequence intubation (RSI) during the initial resuscitation of trauma patients in the emergency department (ED). METHODS: We retrospectively evaluated of the use of Succ and Roc for adult trauma patients undergoing RSI at a Level 1 trauma center. The primary outcome was to identify factors affecting physician choice of paralytic agent for RSI analyzed by cluster analysis using pre-intubation vital signs and early mortality...
November 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29162008/a-perceptual-like-population-coding-mechanism-of-approximate-numerical-averaging
#2
Noam Brezis, Zohar Z Bronfman, Marius Usher
Humans possess a remarkable ability to rapidly form coarse estimations of numerical averages. This ability is important for making decisions that are based on streams of numerical or value-based information, as well as for preference formation. Nonetheless, the mechanism underlying rapid approximate numerical averaging remains unknown, and several competing mechanism may account for it. Here, we tested the hypothesis that approximate numerical averaging relies on perceptual-like processes, based on population coding...
November 21, 2017: Neural Computation
https://www.readbyqxmd.com/read/29157794/analgosedative-interventions-after-rapid-sequence-intubation-with-rocuronium-in-the-emergency-department
#3
Emily Kilber, Daniel H Jarrell, John C Sakles, Christopher J Edwards, Asad E Patanwala
OBJECTIVES: The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention. METHODS: This was a retrospective cohort study conducted in an academic ED in the United States between January 2015 and June 2016...
November 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29149690/a-modified-montpellier-protocol-for-intubating-intensive-care-unit-patients-is-associated-with-an-increase-in-first-pass-intubation-success-and-fewer-complications
#4
Keith A Corl, Christopher Dado, Ankita Agarwal, Nader Azab, Tim Amass, Sarah J Marks, Mitchell M Levy, Roland C Merchant, Jason Aliotta
BACKGROUND: The Montpellier protocol for intubating patients in the intensive care unit (ICU) is associated with a decrease in intubation-related complications. We sought to determine if implementation of a simplified version of the Montpellier protocol that removed selected components and allowed for a variety of pre-oxygenation modalities increased first-pass intubation success and reduced intubation-related complications. METHODS: A prospective pre/post-comparison of a modified Montpellier protocol in two medical and one medical/surgical/cardiac ICU within a hospital system...
November 10, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29142385/blowing-bubbles-helps-intubation
#5
David Howe
Rocuronium is commonly used in preference to suxamethonium for rapid sequence induction in the Intensive Care Unit (ICU). We describe a patient who suffered significant neck trauma following a suicide attempt. On initial presentation to accident and emergency, he was an easy intubation with a Grade 1 view obtained at laryngoscopy. After surgery to repair his neck laceration, he was extubated and discharged from ICU. He later developed a severe aspiration pneumonia and required reintubation. After induction and paralysis with suxamethonium, the best view at laryngoscopy was a Grade 3 despite the use of different laryngoscopes...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29109225/the-consequences-of-sequence-erosion-in-the-evolution-of-recombination-hotspots
#6
REVIEW
Irene Tiemann-Boege, Theresa Schwarz, Yasmin Striedner, Angelika Heissl
Meiosis is initiated by a double-strand break (DSB) introduced in the DNA by a highly controlled process that is repaired by recombination. In many organisms, recombination occurs at specific and narrow regions of the genome, known as recombination hotspots, which overlap with regions enriched for DSBs. In recent years, it has been demonstrated that conversions and mutations resulting from the repair of DSBs lead to a rapid sequence evolution at recombination hotspots eroding target sites for DSBs. We still do not fully understand the effect of this erosion in the recombination activity, but evidence has shown that the binding of trans-acting factors like PRDM9 is affected...
December 19, 2017: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
https://www.readbyqxmd.com/read/29095183/the-effect-of-apneic-oxygenation-on-reducing-hypoxemia-during-rapid-sequence-induction-and-intubation-in-the-acutely-ill-or-injured
#7
Autumn Riddell
Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. Over the last 5 years, there have been several studies published on this topic with differing results. Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29095178/changing-the-emergency-department-s-practice-of-rapid-sequence-intubation-to-reduce-the-incidence-of-hypoxia
#8
Michael D Gooch, Eric Roberts
Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Without preventive measures, oxygen levels may fall rapidly when patients are no longer actively breathing. The incidence of RSI-induced hypoxia may be mitigated with proper education, preoxygenation, positioning, and the utilization of passive (apneic) oxygenation...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29074957/keeping-it-complicated-mitochondrial-genome-plasticity-across-diplonemids
#9
Matus Valach, Sandrine Moreira, Steve Hoffmann, Peter F Stadler, Gertraud Burger
Chromosome rearrangements are important drivers in genome and gene evolution, with implications ranging from speciation to development to disease. In the flagellate Diplonema papillatum (Euglenozoa), mitochondrial genome rearrangements have resulted in nearly hundred chromosomes and a systematic dispersal of gene fragments across the multipartite genome. Maturation into functional RNAs involves separate transcription of gene pieces, joining of precursor RNAs via trans-splicing, and RNA editing by substitution and uridine additions both reconstituting crucial coding sequence...
October 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29054944/anaesthesia-and-orphan-disease-airway-and-anaesthetic-management-in-huntington-s-disease
#10
Phuong Thao Nguyen, Daveena Meeks, Despoina Liotiri
We present a case that highlights the issues surrounding the delivery of a safe general anaesthetic to a patient with Huntington's disease (HD) and bulbar dysfunction. In the case of a 46-year-old patient undergoing laparoscopic percutaneous endoscopic gastrostomy tube insertion, we discuss the rationale behind our chosen method and anaesthetic agents as well as airway issues specific to HD. In a patient whose condition would not allow for an awake fibreoptic intubation, we opted for a modified rapid sequence induction...
October 19, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29046769/factors-that-affect-the-onset-of-action-of-non-depolarizing-neuromuscular-blocking-agents
#11
REVIEW
Yong Byum Kim, Tae-Yun Sung, Hong Seuk Yang
Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29046518/pretreatment-with-oxycodone-simultaneously-reduces-etomidate-induced-myoclonus-and-rocuronium-induced-withdrawal-movements-during-rapid-sequence-induction
#12
Xiaoxia An, Caixia Li, Zayd Sahebally, Xiaohong Wen, Bing Zhao, Xiangming Fang
BACKGROUND Etomidate and rocuronium are often paired in rapid-sequence anesthesia induction. However, the effect of pretreatment with oxycodone on myoclonic and withdrawal movements has not been previously investigated. The aim of this study was to evaluate the effects of oxycodone on the incidence and severity of etomidate-induced myoclonus and rocuronium-induced nociceptive withdrawal movements during rapid-sequence anesthesia induction. MATERIAL AND METHODS We randomly divided 120 patients into the saline group (group S) and the oxycodone group (group O) (n=60 in each group)...
October 19, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/29030741/the-role-of-next-generation-sequencing-in-sarcomas-evolution-from-light-microscope-to-molecular-microscope
#13
REVIEW
Roman Groisberg, Jason Roszik, Anthony Conley, Shreyaskumar R Patel, Vivek Subbiah
PURPOSE OF REVIEW: Sarcomas are rare, heterogeneous group of soft tissue and bone tumors. Precise diagnosis of specific subtypes is challenging using conventional methods. Herein, we review the role of next-generation sequencing (NGS) technology that is used for rapid sequencing of DNA and RNA. RECENT FINDINGS: Recent sarcoma specific studies recommend that molecular genetic testing should be added at diagnosis for appropriate clinical management in addition to diagnosis by expert pathologists...
October 13, 2017: Current Oncology Reports
https://www.readbyqxmd.com/read/29018000/waveform-capnography-an-alternative-to-physician-gestalt-in-determining-optimal-intubating-conditions-after-administration-of-paralytic-agents
#14
Anthony Scoccimarro, Jason R West, Marc Kanter, Nicholas D Caputo
PURPOSE: We sought to evaluate the utility of waveform capnography (WC) in detecting paralysis, by using apnoea as a surrogate determinant, as compared with clinical gestalt during rapid sequence intubation. Additionally, we sought to determine if this improves the time to intubation and first pass success rates through more consistent and expedient means of detecting optimal intubating conditions (ie, paralysis). METHODS: A prospective observational cohort study of consecutively enrolled patients was conducted from April to June 2016 at an academic, urban, level 1 trauma centre in New York City...
October 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28975884/anaesthesia-in-patients-undergoing-esophago-gastro-duodenoscopy-for-suspected-bleeding
#15
Ida Helsø, Martin Risom, Therese Risom Vestergaard, Nicolai Bang Foss, Steffen Rosenstock, Morten Hylander Møller, Lars Hyldborg Lundstrøm, Nicolai Lohse
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a common emergency. Currently, there are no agreed guidelines on the level of anaesthetic support required in patients undergoing acute esophago-gastro-duodendoscopy (EGD). METHODS: An online questionnaire comprising 19 questions was distributed to all members of the Danish Association of Anaesthesiology and Intensive Care (n = 1,418) and the Danish Society of Anaesthesiologists in Training (n = 566). The questions concerned clinical practice for anaesthesia care to patients undergoing EGD for suspected UGIB and availability of local guidelines...
October 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28960597/ideal-cricoid-pressure-is-biomechanically-impossible-during-laryngoscopy
#16
Christopher E Trethewy, Steven R Doherty, Julie M Burrows, Don Clausen
OBJECTIVE: This study was a prospective, randomized controlled trial of rapid sequence intubation (RSI) with cricoid pressure (CP) within the emergency department (ED). The primary aim of the study was to examine the link between ideal CP and the incidence of aspiration. METHOD: Patients > 18 years of age undergoing RSI in the ED of two hospitals in New South Wales, Australia, were randomly assigned to receive measured CP using weighing scales to target the ideal CP range (3...
September 28, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28956237/usefulness-of-oxygen-reserve-index-ori%C3%A2-a-new-parameter-of-oxygenation-reserve-potential-for-rapid-sequence-induction-of-general-anesthesia
#17
Keisuke Yoshida, Tsuyoshi Isosu, Yoshie Noji, Makiko Hasegawa, Yuzo Iseki, Rieko Oishi, Tsuyoshi Imaizumi, Norie Sanbe, Shinju Obara, Masahiro Murakawa
The oxygen reserve index (ORi™) is a new parameter for monitoring oxygen reserve noninvasively. The aim of this study was to examine the usefulness of ORi for rapid sequence induction (RSI). Twenty adult patients who were scheduled for surgical procedures under general anesthesia were enrolled. After attaching a sensor capable of measuring ORi, oxygen (6 L/min) and fentanyl (2 μg/kg) were administered. After 3 min, propofol 2 mg/kg and rocuronium 1 mg/kg were administered without ventilation. Regardless of changes in ORi, tracheal intubation was performed either 2 min after administration of propofol or when percutaneous oxygen saturation (SpO2) reached 98%...
September 27, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28921802/environmental-dna-metabarcoding-transforming-how-we-survey-animal-and-plant-communities
#18
Kristy Deiner, Holly M Bik, Elvira Mächler, Mathew Seymour, Anaïs Lacoursière-Roussel, Florian Altermatt, Simon Creer, Iliana Bista, David M Lodge, Natasha de Vere, Michael E Pfrender, Louis Bernatchez
The genomic revolution has fundamentally changed how we survey biodiversity on earth. High-throughput sequencing ("HTS") platforms now enable the rapid sequencing of DNA from diverse kinds of environmental samples (termed "environmental DNA" or "eDNA"). Coupling HTS with our ability to associate sequences from eDNA with a taxonomic name is called "eDNA metabarcoding" and offers a powerful molecular tool capable of noninvasively surveying species richness from many ecosystems. Here, we review the use of eDNA metabarcoding for surveying animal and plant richness, and the challenges in using eDNA approaches to estimate relative abundance...
September 16, 2017: Molecular Ecology
https://www.readbyqxmd.com/read/28917437/effects-of-intravenous-administration-of-fentanyl-and-lidocaine-on-hemodynamic-responses-following-endotracheal-intubation
#19
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/28913501/acute-poisoning-due-to-ingestion-of-datura-stramonium-a-case-report
#20
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
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