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bag valve mask ventilation

Brian E Driver, Robert F Reardon
Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%...
September 27, 2016: Annals of Emergency Medicine
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
October 3, 2016: Prehospital Emergency Care
Choong Hyun Jo, Gyu Chong Cho, Chang Hee Lee
OBJECTIVE: The purpose of this study was to determine if the over-the-head 2-thumb encircling technique (OTTT) provides better overall quality of cardiopulmonary resuscitation compared with conventional 2-finger technique (TFT) for a lone rescuer in the setting of infant cardiac arrest in ambulance. METHODS: Fifty medical emergency service students were voluntarily recruited to perform lone rescuer infant cardiopulmonary resuscitation for 2 minutes on a manikin simulating a 3-month-old baby in an ambulance...
September 23, 2016: Pediatric Emergency Care
Monica Thallinger, Hege Langli Ersdal, Colin Morley, Carolyn Purington, Øystein Gomo, Estomih Mduma, Joar Eilevstjønn, Ketil Størdal
OBJECTIVE: Positive end expiratory pressure (PEEP) is beneficial when ventilating preterm newborns. The aim was to study whether inexperienced providers were able to generate PEEP during simulated neonatal ventilation, using two novel prototype PEEP valves, on a self-inflating bag without an external gas source. DESIGN: Forty-six nursing students in Tanzania were trained in ventilation with a new Laerdal Upright resuscitator and mask on a NeoNatalie manikin with a newborn resuscitation monitor...
August 29, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
Baruch Zobrist, Monica Casmaer, Michael D April
OBJECTIVE: To compare tidal volume received during single rescuer ventilation with a modified bag-valve mask (BVM) with integrated internal handle vs standard BVM among healthy volunteers using a manikin model. METHODS: This study was a randomized crossover trial of adult healthcare provider volunteers performing ventilation on a manikin. We randomized participants to perform single rescuer ventilation first using either a modified BVM with integrated internal handle or a standard unmodified BVM...
October 2016: American Journal of Emergency Medicine
Alexis L Cates, Scott M Wheatley, Kenneth D Katz
A 22-month-old girl without any significant medical history accidentally consumed a small amount of a therapeutic compounding cream that contained camphor, gabapentin, clonidine, ketoprofen, and lidocaine. Upon presentation to the emergency department, the child exhibited immediate onset of altered mental status with wide fluctuation in her vital signs, which included intermittent apnea requiring bag-valve mask assistance and endotracheal intubation. Serum laboratory analysis measured a clonidine level of 2...
July 23, 2016: Pediatric Emergency Care
M E Sutter, R Gerona, M T Davis, B M Roche, D K Colby, J A Chenoweth, A J Adams, K P Owen, J B Ford, H Black, T E Albertson, Kennon J Heard
OBJECTIVE: The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/acetaminophen. METHODS: Over an 8-day period in late March 2016, 18 patients presented to our institution with exaggerated opioid toxicity. The patients provided a similar history: ingesting their "normal dose" of hydrocodone/acetaminophen tablets but with more pronounced symptoms...
June 20, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
M Fernanda Bellolio, Henrique A Puls, Jana L Anderson, Waqas I Gilani, M Hassan Murad, Patricia Barrionuevo, Patricia J Erwin, Zhen Wang, Erik P Hess
OBJECTIVE AND DESIGN: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. SETTING: ED. PARTICIPANTS: Children. INTERVENTIONS: Procedural sedation...
2016: BMJ Open
Philip Salen, Michelle Grossman, Michael Grossman, Anthony Milazzo, Jill Stoltzfus
STUDY OBJECTIVES: Ketamine and etomidate are used for procedural sedation (PS) to facilitate the performance of painful procedures. We hypothesized that ketamine produces adequate and comparable sedation conditions for dislocated large joint reduction when compared to etomidate and results in fewer adverse events. METHODS: This Institutional Review Board approved prospective trial compared a convenience sample of subjects, who were randomized to receive either ketamine or etomidate for PS to facilitate reduction of large joint dislocations...
April 2016: International Journal of Critical Illness and Injury Science
A Khoury, F S Sall, A De Luca, A Pugin, S Pili-Floury, L Pazart, G Capellier
Introduction. Manikin-based studies for evaluation of ventilation performance show high heterogeneity in the analysis and experimental methods used as we pointed out in previous studies. In this work, we aim to evaluate these potential limitations and propose a new analysis methodology to reliably assess ventilation performance. Methods. One hundred forty healthcare providers were selected to ventilate a manikin with two adult self-inflating bags in random order. Ventilation parameters were analysed using different published analysis methods compared to ours...
2016: BioMed Research International
Marcel Simon, Christian Wachs, Stephan Braune, Geraldine de Heer, Daniel Frings, Stefan Kluge
BACKGROUND: Critically ill patients with respiratory failure undergoing intubation have an increased risk of hypoxemia-related complications. Delivering oxygen via a high-flow nasal cannula (HFNC) has theoretical advantages and is increasingly used. This study was conducted to compare HFNC with bag-valve-mask (BVM) for preoxygenation and to assess oxygenation during intubation in subjects with hypoxemic respiratory failure. METHODS: This study was a randomized controlled trial including 40 critically ill subjects with hypoxemic respiratory failure who received either HFNC or BVM for preoxygenation before intubation in the ICU...
September 2016: Respiratory Care
David A Pearson, R Darrell Nelson, Lisa Monk, Clark Tyson, James G Jollis, Christopher B Granger, Claire Corbett, Lee Garvey, Michael S Runyon
BACKGROUND: Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown...
August 2016: Resuscitation
Behrad Ziapour
BACKGROUND: To describe the successful management of a patient with severe dyspnea and hypoxia due to tracheal stenosis by the application of a novel bridging technique-anterograde tracheal catheterization-prior to tracheostomy. CASE PRESENTATION: A 55-year-old woman entered the Emergency Department with severe dyspnea, tachypnea, and stridor and a pulse oximetry reading of 60 %. An attempt at intubation failed because of tracheal stenosis discovered 3-4 cm distal to the vocal cords, which had been formed as a complication of intubation the previous month...
2016: Journal of Cardiothoracic Surgery
Trent Reed, Matthew Pirotte, Mary McHugh, Laura Oh, Shannon Lovett, Amy E Hoyt, Donna Quinones, William Adams, Gregory Gruener, William C McGaghie
INTRODUCTION: Simulation-based mastery learning (SBML) improves procedural skills among medical trainees. We employed an SBML method that includes an asynchronous knowledge acquisition portion and a hands-on skill acquisition portion with simulation to assess senior medical student performance and retention of the following 6 core clinical skills: (a) ultrasound-guided peripheral intravenous placement, (b) basic skin laceration repair, (c) chest compressions, (d) bag-valve mask ventilation, (e) defibrillator management, and (f) code leadership...
June 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Kenneth W Dodd, Ashley M Strobel, Brian E Driver, Robert F Reardon
Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ongoing. A 5-week-old female infant required resuscitation for hypoxemic respiratory failure caused by rhinovirus with pneumonia. Bag-valve-mask ventilation led to gastric insufflation that compromised ventilation, thereby interfering with intubation because of precipitous oxygen desaturation during laryngoscopy...
October 2016: Annals of Emergency Medicine
Jason P Mihalik, Robert C Lynall, Melissa A Fraser, Laura C Decoster, Valerie J De Maio, Amar P Patel, Erik E Swartz
OBJECTIVE: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators...
September 2016: Prehospital Emergency Care
Tobias Piegeler, Bernard Roessler, Georg Goliasch, Henrik Fischer, Martin Schlaepfer, Susanna Lang, Kurt Ruetzler
BACKGROUND: Chest compressions and ventilation are lifesaving tasks during cardio-pulmonary resuscitation (CPR). Besides oxygenation, endotracheal intubation (ETI) during CPR is performed to avoid aspiration of gastric contents. If intubation is difficult or impossible, supraglottic airway devices are utilized. We tested six different airway devices regarding their potential to protect against regurgitation and aspiration during CPR in a randomized experimental human cadaver study. METHODS: Five-hundred ml of 0...
May 2016: Resuscitation
Troy E Reihsen, Laszlo Alberti, Jason Speich, Lauren H Poniatowski, Danielle Hart, Robert M Sweet
BACKGROUND: Training health care providers to manage common life-threatening traumatic injuries is an important endeavor. A fresh perfused cadaveric model with high anatomic and tissue fidelity was developed to assess performance of hemorrhage and airway management skills during a simulated polytrauma scenario. METHODS: Fresh human cadavers were obtained within 96 hours of death. Hemorrhage from a right traumatic amputation and left inguinal wound was simulated using cannulation of the right popliteal and left femoral artery, respectively...
May 2016: Journal of Trauma and Acute Care Surgery
Henry E Wang, David K Prince, Shannon W Stephens, Heather Herren, Mohamud Daya, Neal Richmond, Jestin Carlson, Craig Warden, M Riccardo Colella, Ashley Brienza, Tom P Aufderheide, Ahamed H Idris, Robert Schmicker, Susanne May, Graham Nichol
Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-h survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design...
April 2016: Resuscitation
Takuya Okada, Moritoki Egi, Hitoaki Sato, Yuki Nomura, Masako Okada, Shinichiro Izuta, Satoshi Mizobuchi
We report a case of delayed respiratory depression due to accidental subcutaneous opioid infusion. A healthy 33-year-old woman underwent orthopedic surgery under general anesthesia. Before the end of the operation, it was noticed that a part of the opioid infusion had been administered subcutaneously. About 15 min after tracheal extubation, the patient developed respiratory depression and loss of consciousness. The patient recovered with the use of jaw lift together with bag-valve-mask ventilation. We believe that accidental subcutaneous opioid accumulation may have caused the respiratory depression...
June 2016: Journal of Anesthesia
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