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EM Airway

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By Terren Trott
John C Sakles
Rapid sequence intubation (RSI) is the most common method of airway control in the emergency department (ED).(1,2) Administration of an anesthetic agent and a neuromuscular blocking agent (NMBA) optimizes conditions for tracheal intubation and is thought to minimize the risk of aspiration.(3-10) Evidence suggests that RSI improves first pass success and reduces complications in the critically ill.(11-14) This article is protected by copyright. All rights reserved.
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ruan Vlok, Matthew Binks, Thomas Melhuish, Rhys Holyoak, Leigh White
No abstract text is available yet for this article.
July 22, 2017: American Journal of Emergency Medicine
A K Nørskov, C V Rosenstock, J Wetterslev, G Astrup, A Afshari, L H Lundstrøm
Both the American Society of Anesthesiologists and the UK NAP4 project recommend that an unspecified pre-operative airway assessment be made. However, the choice of assessment is ultimately at the discretion of the individual anaesthesiologist. We retrieved a cohort of 188 064 cases from the Danish Anaesthesia Database, and investigated the diagnostic accuracy of the anaesthesiologists' predictions of difficult tracheal intubation and difficult mask ventilation. Of 3391 difficult intubations, 3154 (93%) were unanticipated...
March 2015: Anaesthesia
Nicholas Caputo, Ben Azan, Rui Domingues, Lee Donner, Mark Fenig, Douglas Fields, Robert Fraser, Karlene Hosford, Richard Iuorio, Marc Kanter, Moira McCarty, Thomas Parry, Andaleeb Raja, Mary Ryan, Blaine Williams, Hemlata Sharma, Daniel Singer, Chris Shields, Sandra Scott, Jason R West
OBJECTIVES: Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. METHODS: A randomized controlled trial was conducted at an academic, urban, level 1 trauma center...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
John C Sakles, Jarrod M Mosier, Stephen Chiu, Samuel M Keim
BACKGROUND: Video laryngoscopy has, in recent years, become more available to emergency physicians. However, little research has been conducted to compare their success to conventional direct laryngoscopy. OBJECTIVES: To compare the success rates of GlideScope(®) (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) with direct laryngoscopy (DL) for emergency department (ED) intubations. METHODS: This was a 24-month retrospective observational study of all patients intubated in a single academic ED with a level I trauma center...
April 2012: Journal of Emergency Medicine
Uday Jain, Maureen McCunn, Charles E Smith, Jean-Francois Pittet
There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. General recommendations for the management of the traumatized airway are summarized in table 5. Airway trauma may not be readily apparent, and its evaluation requires a high level of suspicion for airway disruption and compression. For patients with facial trauma, control of the airway may be significantly impacted by edema, bleeding, inability to clear secretions, loss of bony support, and difficulty with face mask ventilation...
January 2016: Anesthesiology
Julie Mayglothling, Therese M Duane, Michael Gibbs, Maureen McCunn, Eric Legome, Alexander L Eastman, James Whelan, Kaushal H Shah
BACKGROUND: The ABCs of trauma resuscitation begin with the airway evaluation, and effective airway management is imperative in the care of a patient with critical injury. The Eastern Association for the Surgery of Trauma Practice Management Guidelines committee aimed to update the guidelines for emergency tracheal intubation (ETI) published in 2002. These guidelines were made to assist clinicians with decisions regarding airway management for patients immediately following traumatic injury...
November 2012: Journal of Trauma and Acute Care Surgery
Lucas Oliveira J E Silva, Daniel Cabrera, Patricia Barrionuevo, Rebecca L Johnson, Patricia J Erwin, M Hassan Murad, M Fernanda Bellolio
STUDY OBJECTIVE: We conduct a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation during emergency intubation. METHODS: We searched Ovid MEDLINE, Ovid EMBASE, Ovid CENTRAL, and Scopus databases for randomized controlled trials and observational studies from 2006 until July 2016, without language restrictions. Gray literature,, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate first-pass success rates, incidence of hypoxemia, and lowest peri-intubation SpO2 between apneic oxygenation and standard oxygenation cases...
July 13, 2017: Annals of Emergency Medicine
David McQuade, Matthew R Miller, Clare Hayes-Bradley
BACKGROUND: A critical safety component of emergency anesthesia is the avoidance of hypoxemia during the apneic phase of a rapid sequence intubation. Preoxygenation with a bag valve mask (BVM) or anesthetic circuit may be improved with supplemental oxygen by nasal cannula (NC) if there is a mask leak. In addition, NC is recommended for apneic oxygenation after induction and may be placed before preoxygenation. However, the optimum NC flow rate for preoxygenation or whether the presence of NC alone creates a mask leak remains unclear...
July 26, 2017: Anesthesia and Analgesia
Anna Lee, Lawrence T Y Fan, Tony Gin, Manoj K Karmakar, Warwick D Ngan Kee
The original and modified Mallampati tests are commonly used to predict the difficult airway, but there is controversy regarding their accuracy. We searched MEDLINE and other databases for prospective studies of patients undergoing general anesthesia in which the results of a preoperative Mallampati test were compared with the subsequent rate of difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation as reference tests). Forty-two studies enrolling 34,513 patients were included...
June 2006: Anesthesia and Analgesia
M Lewis, S Keramati, J L Benumof, C C Berry
BACKGROUND: Previous studies have suggested that the degree of visibility of oropharyngeal structures (OP class) and mandibular space (MS) length can predict difficult laryngoscopy. However, those studies were either inconsistent or omit description of how to perform these tests with regard to body, head and tongue position, and the use of phonation, hyoid versus thyroid cartilage and inside versus outside of the mentum. The purpose of this investigation was to determine which method of testing best predicts difficult laryngoscopy...
July 1994: Anesthesiology
S R Mallampati, S P Gatt, L D Gugino, S P Desai, B Waraksa, D Freiberger, P L Liu
It has been suggested that the size of the base of the tongue is an important factor determining the degree of difficulty of direct laryngoscopy. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure. The system was evaluated in 210 patients. The degree of difficulty in visualizing these three structures was an accurate predictor of difficulty with direct laryngoscopy (p less than 0...
July 1985: Canadian Anaesthetists' Society Journal
Zulfiqar Mohammad, Bekele Afessa, Javier D Finkielman
INTRODUCTION: Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus. The influence of etomidate administration on the incidence of relative adrenal insufficiency in patients with septic shock has not been formally investigated. The objective of this study was to determine the incidence of relative adrenal insufficiency in patients with septic shock after etomidate administration compared with patients with septic shock who did not receive etomidate...
2006: Critical Care: the Official Journal of the Critical Care Forum
Matthew J Binks, Rhys S Holyoak, Thomas M Melhuish, Ruan Vlok, Elyse Bond, Leigh D White
BACKGROUND: Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting. AIM: To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval...
June 24, 2017: American Journal of Emergency Medicine
Stephen Tai, Miguel Mascaro, Nira A Goldstein
OBJECTIVES: We evaluated the clinical characteristics of patients treated for angioedema, and determined the factors associated with the clinical course. METHODS: We performed a chart review of 367 episodes presenting from 1997 through 2008. RESULTS: The mean (+/-SD) age was 51.8 +/- 20.1 years; 65.7% of the episodes occurred in female patients; 62.4% of the episodes were in African American patients. The patients were on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for 49...
December 2010: Annals of Otology, Rhinology, and Laryngology
Daniel LoVerde, Daniel Clark Files, Guha Krishnaswamy
OBJECTIVES: Angioedema is a potentially life-threatening occurrence that is encountered by critical care providers. The mechanistic understanding of angioedema syndromes has improved in recent years, and novel medications are available that improve outcomes from these syndromes. This clinically focused review will describe the underlying genetics, pathophysiology, classification and treatment of angioedema syndromes, with an emphasis on the novel pharmacologic agents that have recently become available for acute treatment...
April 2017: Critical Care Medicine
T Murphy, B Howes
No abstract text is available yet for this article.
June 2017: Anaesthesia
Ali Pourmand, Chelsea Robinson, Kelsey Dorwart, Francis O'Connell
Transient oxygen desaturation during emergency department intubation is an event with potentially devastating consequences. Pre-oxygenation is an important means of increasing a patient's oxygen reserve and duration of safe apnea prior to intubation. In the emergent setting, important modifications to pre-oxygenation techniques need to be considered to best manage critically ill patients. In this review, we discuss recent updates in pre-oxygenation techniques and evaluate the evidence supporting both commonly used and newly emerging techniques for pre-oxygenation, assessing nature and level of illness, the best delivery method of oxygen, using delayed sequence intubation in patients who cannot tolerate non-invasive pre-oxygenation and using apneic oxygenation via nasal cannula and non-rebreather mask during intubation...
August 2017: American Journal of Emergency Medicine
Kaushal H Shah, Brian Kwong, Alberto Hazan, Rebecca Batista, David H Newman, Dan Wiener
BACKGROUND: The difficulties with gum elastic bougie (GEB) use in the emergency department (ED) have never been studied prospectively. OBJECTIVES: To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED. METHODS: We conducted a prospective, observational study of GEB practices in our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000 patients. Laryngoscopists performing a GEB-assisted intubation completed a structured data form after laryngoscopy, recording patient characteristics, grade of laryngeal view (using the modified Cormack-Lehane classification), reason for GEB use, and problems encountered...
October 2011: Journal of Emergency Medicine
2017-06-28 09:41:16
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