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https://www.readbyqxmd.com/read/28505486/respiratory-support-techniques-to-avoid-desaturation-in-critically-ill-patients-requiring-endotracheal-intubation-a-systematic-review-and-meta-analysis
#1
REVIEW
Vincenzo Russotto, Andrea Cortegiani, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano
PURPOSE: To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. METHODS: We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. RESULTS: Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients)...
May 8, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28402986/no-small-matter-pediatric-resuscitation
#2
Taylor McCormick, Kevin McVaney, Paul E Pepe
PURPOSE OF REVIEW: To present advancements in pediatric cardiac arrest research, highlighting articles most relevant to clinical practice published since the latest international guidelines for cardiopulmonary resuscitation (CPR). RECENT FINDINGS: Clinical trials examining targeted temperature management in children support avoidance of hyperthermia for both pediatric in-hospital cardiac arrest (PIHCA) and out-of-hospital cardiac arrest (POHCA), but no statistically significant outcome differences were confirmed comparing 33 and 36 °C in the limited populations studied...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28295147/a-prospective-randomised-trial-of-pre-oxygenation-strategies-available-in-the-pre-hospital-environment
#3
C J Groombridge, E Ley, M Miller, T Konig
Pre-oxygenation before tracheal intubation aims to increase safe apnoea duration by denitrogenation of the functional residual capacity of the lungs, and increasing oxygen stores at the onset of apnoea. Pre-oxygenation options in the pre-hospital environment are limited due to oxygen availability and equipment portability. The aim of this study was to evaluate the effectiveness of strategies available in this setting. This was a prospective, randomised, crossover study of 30 healthy volunteers who underwent 3-min periods of pre-oxygenation by tidal volume breathing with a non-rebreather mask, a bag-valve-mask and a portable ventilator...
March 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28285866/obstructed-infradiaphragmatic-total-anomalous-pulmonary-venous-return-in-a-13-day-old-infant-presenting-acutely-to-the-emergency-department-a-case-report
#4
Elizabeth A Siacunco, Garrett S Pacheco, Dale P Woolridge
BACKGROUND: Total anomalous pulmonary venous return (TAPVR) is an uncommon congenital heart defect. Obstructed forms are more severe, and typically present earlier in life, usually in the immediate newborn period, with symptoms of severe cyanosis and respiratory failure. CASE REPORT: A 13-day-old boy presented to the emergency department (ED) with respiratory extremis. He appeared cyanotic and limp, and was found to have significant hypoxia with oxygen saturation of 40%...
March 9, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28267617/effect-of-prehospital-advanced-airway-management-for-pediatric-out-of-hospital-cardiac-arrest
#5
Naoko Ohashi-Fukuda, Tatsuma Fukuda, Kent Doi, Naoto Morimura
BACKGROUND: Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce. METHODS: This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients aged between 1 and 17 years old...
March 4, 2017: Resuscitation
https://www.readbyqxmd.com/read/28176512/respiratory-adverse-events-during-upper-digestive-endoscopies-in-children-under-ketamine-sedation
#6
Jose C Flores-González, Alfonso M Lechuga Sancho, Mónica Saldaña Valderas, Gema Jimenez Gomez, Maria D Cruzado Garcia, Cristina Perez Aragon, Jose A Blanca Garcia
BACKGROUND: There is no evidence of the need for oxygen supplementation during upper digestive endoscopies under Ketamine sedation in children, and the latest recommendations specifically state that it is not mandatory for the procedure. The aim of our study is to assess the incidence of respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation when performed without oxygen supplementation, in accordance with the latest recommendations. METHODS: 88 children undergoingketamine sedation for programmed upper digestive endoscopy at our Pediatric Intensive Care Unit were included...
February 7, 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/28078762/competence-in-the-use-of-supraglottic-airways-by-australian-surf-lifesavers-for-cardiac-arrest-ventilation-in-a-manikin
#7
Lachlan Holbery-Morgan, Cara Angel, Michelle Murphy, James Carew, Finn Douglas, Robert Murphy, Natalie Hood, Andrew Rechtman, Christopher Scarff, Nicholas Simpson, Andrew Stewardson, Daniel Steinfort, Sam Radford, Ned Douglas, Douglas Johnson
OBJECTIVES: Lifesavers in Australia are taught to use pocket mask (PM) rescue breathing and bag valve mask (BVM) ventilation, despite evidence that first responders might struggle with these devices. Novices have successfully used the Laryngeal Mask Airway (LMA) Supreme and iGel devices previously, but there has been no previous comparison of the ability to train lifesavers to use the supraglottic airways compared to standard techniques for cardiac arrest ventilation. METHODS: The study is a prospective educational intervention whereby 113 lifesavers were trained to use the LMA and iGel supraglottic airways...
February 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28051284/analysis-of-out-of-hospital-cardiac-arrest-in-croatia-survival-bystander-cardiopulmonary-resuscitation-and-impact-of-physician-s-experience-on-cardiac-arrest-management-a-single-center-observational-study
#8
Anita Lukić, Ileana Lulić, Dinka Lulić, Zoran Ognjanović, Davorin Cerovečki, Siniša Telebar, Ivica Mašić
AIM: To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaľdin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management. METHODS: We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaľdin (EMSVz), Croatia, from 2007-2013...
December 31, 2016: Croatian Medical Journal
https://www.readbyqxmd.com/read/27836871/patient-safety-events-in-out-of-hospital-paediatric-airway-management-a-medical-record-review-by-the-csi-ems
#9
Matthew Hansen, Garth Meckler, William Lambert, Caitlin Dickinson, Kathryn Dickinson, Joshua Van Otterloo, Jeanne-Marie Guise
OBJECTIVE: To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management. METHODS: We conducted a retrospective cross-sectional medical record review of all 'lights and sirens' emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing...
November 11, 2016: BMJ Open
https://www.readbyqxmd.com/read/27692755/apnea-after-low-dose-ketamine-sedation-during-attempted-delayed-sequence-intubation
#10
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%...
January 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27690714/can-ems-providers-provide-appropriate-tidal-volumes-in-a-simulated-adult-sized-patient-with-a-pediatric-sized-bag-valve-mask
#11
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)...
January 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27668920/two-thumb-encircling-technique-over-the-head-of-patients-in-the-setting-of-lone-rescuer-infant-cpr-occurred-during-ambulance-transfer-a-crossover-simulation-study
#12
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
https://www.readbyqxmd.com/read/27573519/neonatal-ventilation-with-a-manikin-model-and-two-novel-peep-valves-without-an-external-gas-source
#13
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...
May 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27498918/single-rescuer-ventilation-using-a-bag-valve-mask-with-internal-handle-a-randomized-crossover-trial
#14
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/27455340/clonidine-overdose-in-a-toddler-due-to-accidental-ingestion-of-a-compounding-cream
#15
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
https://www.readbyqxmd.com/read/27322591/fatal-fentanyl-one-pill-can-kill
#16
Mark E Sutter, Roy R Gerona, M Thais Davis, Bailey M Roche, Daniel K Colby, James A Chenoweth, Axel J Adams, Kelly P Owen, Jonathan B Ford, Hugh B Black, Timothy E Albertson
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, a total of 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...
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27311910/incidence-of-adverse-events-in-paediatric-procedural-sedation-in-the-emergency-department-a-systematic-review-and-meta-analysis
#17
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
https://www.readbyqxmd.com/read/27308256/a-comparison-of-ketamine-versus-etomidate-for-procedural-sedation-for-the-reduction-of-large-joint-dislocations
#18
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
https://www.readbyqxmd.com/read/27294119/evaluation-of-bag-valve-mask-ventilation-in-manikin-studies-what-are-the-current-limitations
#19
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
https://www.readbyqxmd.com/read/27274092/high-flow-nasal-cannula-versus-bag-valve-mask-for-preoxygenation-before-intubation-in-subjects-with-hypoxemic-respiratory-failure
#20
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
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