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Airway

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190 papers 1000+ followers Interesting articles in airway management, particularly emergent.
By Brian Gacioch EM intern starting 2014; 12 years 911, CCT, and flight paramedic; interest areas critical care medicine, airway, point of care ultrasound, medical education.
https://www.readbyqxmd.com/read/26921968/techniques-and-trends-success-rates-and-adverse-events-in%C3%A2-emergency-department-pediatric-intubations-a-report-from%C3%A2-the-national-emergency-airway-registry
#1
Daniel J Pallin, Richard C Dwyer, Ron M Walls, Calvin A Brown
STUDY OBJECTIVE: We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. METHODS: Academic and community EDs in the United States, Canada, and Australia recorded data electronically, from 2002 to 2012, with verified greater than or equal to 90% reporting. RESULTS: Ten of 18 participating centers provided qualifying data, reporting 1,053 encounters. Emergency physicians initiated 85% of intubations...
May 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26836712/first-pass-success-without-hypoxemia-is-increased-with-the-use-of-apneic-oxygenation-during-rapid-sequence-intubation-in-the-emergency-department
#2
John C Sakles, Jarrod M Mosier, Asad E Patanwala, Brittany Arcaris, John M Dicken
OBJECTIVES: The objective was to determine the effect of apneic oxygenation (AP OX) on first pass success without hypoxemia (FPS-H) in adult patients undergoing rapid sequence intubation (RSI) in the emergency department (ED). METHODS: Continuous quality improvement data were prospectively collected on all patients intubated in an academic ED from July 1, 2013, to June 30, 2015. During this period the use of AP OX was introduced and encouraged for all patients undergoing RSI in the ED...
June 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26850232/direct-versus-video-laryngoscopy-using-the-c-mac-for-tracheal-intubation-in-the-emergency-department-a-randomized-controlled-trial
#3
RANDOMIZED CONTROLLED TRIAL
Brian E Driver, Matthew E Prekker, Johanna C Moore, Alexandra L Schick, Robert F Reardon, James R Miner
BACKGROUND: Direct laryngoscopy (DL) has long been the most common approach for emergency endotracheal intubation, although the use of video laryngoscopy (VL) is becoming more widespread. Current observational data suggest that VL has higher first-pass success, although randomized trials are lacking. OBJECTIVES: The objective was to compare first-pass success in patients undergoing emergency intubation with DL or VL using a C-MAC device. METHODS: This was an open-label, prospective, randomized, controlled trial in an academic emergency department of patients undergoing emergency intubation with a plan of DL for the first attempt...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26556848/difficult-airway-society-2015-guidelines-for-management-of-unanticipated-difficult-intubation-in-adults
#4
COMMENT
C Frerk, V S Mitchell, A F McNarry, C Mendonca, R Bhagrath, A Patel, E P O'Sullivan, N M Woodall, I Ahmad
These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction...
December 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26578526/effectiveness-and-risks-of-cricoid-pressure-during-rapid-sequence-induction-for-endotracheal-intubation
#5
REVIEW
Catherine M Algie, Robert K Mahar, Hannah B Tan, Greer Wilson, Patrick D Mahar, Jason Wasiak
BACKGROUND: Rapid sequence induction (RSI) for endotracheal intubation is a technique widely used in anaesthesia, emergency and intensive care medicine to secure an airway in patients deemed at risk of pulmonary aspiration. Cricoid pressure is conceptually used to reduce the risk of aspiration by compressing the oesophagus. OBJECTIVES: To identify and evaluate all randomized controlled trials (RCTs) involving participants undergoing elective or emergency airway management via RSI and compare participants who have cricoid pressure administered with participants who do not have cricoid pressure administered...
2015: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26014437/ventilator-strategies-and-rescue-therapies-for-management-of-acute-respiratory-failure-in-the-emergency-department
#6
REVIEW
Jarrod M Mosier, Cameron Hypes, Raj Joshi, Sage Whitmore, Sairam Parthasarathy, Charles B Cairns
Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%...
November 2015: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26164643/incidence-and-duration-of-continuously-measured-oxygen-desaturation-during-emergency-department-intubation
#7
Jerry B Bodily, Heather R Webb, Steve J Weiss, Darren A Braude
STUDY OBJECTIVE: Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. METHODS: This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED...
March 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/25733113/preoxygenation-reduces-desaturation-events-and-improves-intubation-success
#8
Daniel P Davis, Justin Lemieux, John Serra, William Koenig, Steve A Aguilar
OBJECTIVE: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and is associated with increased morbidity and mortality. Preoxygenation with positive pressure ventilation by bag valve mask may delay the onset of desaturation. The purpose of this study was to evaluate implementation of a targeted preoxygenation protocol including the use of positive pressure ventilation on desaturation events and intubation success during air medical RSI. METHODS: The RSI air medical program airway training model was modified to target an oxygen saturation as measured by pulse oximetry value of ≥ 93% before initial laryngoscopy...
March 2015: Air Medical Journal
https://www.readbyqxmd.com/read/25996773/the-use-of-a-video-laryngoscope-by-emergency-medicine-residents-is-associated-with-a-reduction-in-esophageal-intubations-in-the-emergency-department
#9
John C Sakles, Parisa P Javedani, Eric Chase, Jessica Garst-Orozco, Jose M Guillen-Rodriguez, Uwe Stolz
OBJECTIVES: The purpose of this investigation was to compare the incidence of esophageal intubations (EIs) when emergency medicine (EM) residents used a direct laryngoscope (DL) versus a video laryngoscope (VL) for intubation attempts in the emergency department (ED). METHODS: Prospectively collected continuous quality improvement data on tracheal intubations performed by EM residents in an academic ED over a 6-year period were retrospectively analyzed. Following each intubation, EM residents completed a data form with patient, intubation, and operator characteristics...
June 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26198864/the-inaccuracy-of-using-landmark-techniques-for-cricothyroid-membrane-identification-a-comparison-of-three-techniques
#10
RANDOMIZED CONTROLLED TRIAL
Aaron E Bair, Rupinder Chima
OBJECTIVES: Successful cricothyrotomy is predicated on accurate identification of the cricothyroid membrane (CTM) by palpation of superficial anatomy. However, recent research has indicated that accuracy of the identification of the CTM can be as low as 30%, even in the hands of skilled providers. To date, there are very little data to suggest how to best identify this critical landmark. The objective was to compare three different methods of identifying the CTM. METHODS: A convenience sample of patients and physician volunteers who met inclusion criteria was consented...
August 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25779855/factors-associated-with-oxyhemoglobin-desaturation-during-rapid-sequence-intubation-in-a-pediatric-emergency-department-findings-from-multivariable-analyses-of-video-review-data
#11
Andrea S Rinderknecht, Matthew R Mittiga, Jareen Meinzen-Derr, Gary L Geis, Benjamin T Kerrey
OBJECTIVES: In a video-based study of rapid sequence intubation (RSI) in a pediatric emergency department (PED), 33% of children experienced oxyhemoglobin desaturation (SpO2 < 90%). To inform targeted improvement interventions, we planned multivariable analyses to identify patient and process variables (including time-based data around performance of key RSI process elements uniquely available from video review) associated with desaturation during pediatric RSI. METHODS: These were planned analyses of data collected during a retrospective, video-based study of RSI in a high-volume, academic PED...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25191185/external-laryngeal-manipulation-done-by-the-laryngoscopist-makes-the-best-laryngeal-view-for-intubation
#12
Mohamed Shaaban Ali, Mohamed Hassan Bakri, Hesham Ali Mohamed, Hany Shehab, Waleed Al Taher
PURPOSE: External laryngeal manipulation (ELM) is used to get better laryngeal view during direct laryngoscopy. This study was designed to test the hypothesis that ELM done by the intubating anesthetist (laryngoscopist) offers the best laryngeal view for tracheal intubation. MATERIALS AND METHOD: A total of 160 patients underwent different surgical procedures were included in this study. Percentage of glottic opening (POGO) score and Cormack and Lehane scale were used as outcome measures for comparison between different laryngoscopic views...
July 2014: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/22313556/emergency-surgical-cricothyroidotomy-24-successful-cases-leading-to-a-simple-scalpel-finger-tube-method
#13
Bruce R Paix, William M Griggs
Surgical airway access justifiably remains the final option for managing the 'can't intubate can't ventilate' situation, but available techniques are often complicated and might require special equipment. This paper reports on the real world experience of two experienced Australian medical specialists with backgrounds in Anaesthesia and Aeromedical Retrieval who performed 24 surgical airways, mainly under adverse prehospital conditions, over a combined 40 years of practice. All attempts were successful, the majority through a simple open 'scalpel-finger-tube' method, which is described here...
February 2012: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/25064742/the-effect-of-ketamine-on-intracranial-and-cerebral-perfusion-pressure-and-health-outcomes-a-systematic-review
#14
REVIEW
Lindsay Cohen, Valerie Athaide, Maeve E Wickham, Mary M Doyle-Waters, Nicholas G W Rose, Corinne M Hohl
STUDY OBJECTIVE: We synthesize the available evidence on the effect of ketamine on intracranial and cerebral perfusion pressures, neurologic outcomes, ICU length of stay, and mortality. METHODS: We developed a systematic search strategy and applied it to 6 electronic reference databases. We completed a gray literature search and searched medical journals as well as the bibliographies of relevant articles. We included randomized and nonrandomized prospective studies that compared the effect of ketamine with another intravenous sedative in intubated patients and reported at least 1 outcome of interest...
January 2015: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/25113425/which-nostril-should-be-used-for-nasotracheal-intubation-the-right-or-left-a-randomized-clinical-trial
#15
RANDOMIZED CONTROLLED TRIAL
Aiji Boku, Hiroshi Hanamoto, Yohsuke Hirose, Chiho Kudo, Yoshinari Morimoto, Mistutaka Sugimura, Hitoshi Niwa
STUDY OBJECTIVE: To determine which nostril is more suitable for nasotracheal intubation in patients with normal patency of both nostrils. DESIGN: Prospective, randomized clinical trial. SETTING: Operating room of a university medical center. PATIENTS: 191 ASA physical status 1 and 2 patients scheduled for elective oral surgery requiring general anesthesia with nasotracheal intubation. INTERVENTIONS: Patients were randomized to two groups to undergo nasotracheal intubation through the right nostril (Group R; n = 96) or the left nostril (n = 95)...
August 2014: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/25158992/comparison-of-intubation-performance-by-emergency-medicine-residents-using-gum-elastic-bougie-versus-standard-stylet-in-simulated-easy-and-difficult-intubation-scenarios
#16
COMPARATIVE STUDY
Ryan Walsh, Laura Cookman, Emily Luerssen
OBJECTIVE: We sought to evaluate the success rate and time to endotracheal intubation by emergency medicine residents with stylet reinforced endotracheal tube (ETT-S) versus intubation with a gum elastic bougie (GEB) in simulated easy and difficult airways on a cadaveric model. METHODS: The study was a prospective cross-over design using a cohort of 29 emergency medicine residents. A fresh frozen cadaver was used in either standard positioning to facilitate a Cormack Lehane Grade 1 laryngoscopy, or with a hard cervical collar applied a Cormack Lehane Grade 3 laryngoscopy...
October 2014: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/25174290/cricothyrotomy-performed-with-the-melker%C3%A2-set-or-the-quicktrach%C3%A2-kit-procedure-times-learning-curves-and-operators-preference
#17
C E Buonopane, V Pasta, D Sottile, L Del Vecchio, A Maturo, R Merola, A Panunzi, P Urciuoli, V D'Orazi
BACKGROUND: Cricothyroidotomy is a surgical airway technique in which an airway device is inserted into the trachea through an incision made at the cricothyroid membrane. It is used for the management of the "difficult airways" and may be a lifesaving procedure in "can't intubate, can't oxygenate" situations. However, many healthcare professionals working in emergency settings have little of no experience with this procedure. Achievement of theoretical and practical knowledge of different cricothyrotomy techniques is therefore a fundamental prerequisite for those healthcare professionals...
July 2014: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/20363528/emergency-department-management-of-the-airway-in-obese-adults
#18
REVIEW
James Dargin, Ron Medzon
Airway management in obese adults can be challenging, and much of the literature on this subject focuses on elective surgical cases, rather than acutely ill patients. In this article, we review the emergency department evaluation of the airway in obesity, discussing anatomy, physiology, and pharmacology. In addition, we describe techniques and devices used to improve intubating conditions in the obese patient. After our review of the relevant literature, we conclude that research in this particular area of acute care remains in its infancy...
August 2010: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/21107105/prehospital-rapid-sequence-intubation-improves-functional-outcome-for-patients-with-severe-traumatic-brain-injury-a-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Stephen A Bernard, Vina Nguyen, Peter Cameron, Kevin Masci, Mark Fitzgerald, David J Cooper, Tony Walker, B Paramed Std, Paul Myles, Lynne Murray, David, Taylor, Karen Smith, Ian Patrick, John Edington, Andrew Bacon, Jeffrey V Rosenfeld, Rodney Judson
OBJECTIVE: To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. BACKGROUND: Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival...
December 2010: Annals of Surgery
https://www.readbyqxmd.com/read/21846380/succinylcholine-versus-rocuronium-for-rapid-sequence-intubation-in-intensive-care-a-prospective-randomized-controlled-trial
#20
RANDOMIZED CONTROLLED TRIAL
Stephan C Marsch, Luzius Steiner, Evelyne Bucher, Hans Pargger, Martin Schumann, Timothy Aebi, Patrick R Hunziker, Martin Siegemund
INTRODUCTION: Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI...
August 16, 2011: Critical Care: the Official Journal of the Critical Care Forum
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