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EM Airway

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By Terren Trott
Richard M Levitan, James T Pisaturo, William C Kinkle, Kenneth Butler, Worth W Everett
OBJECTIVES: Malleable stylets improve maneuverability and control during tube insertion, but after passage through the vocal cords the stiffened tracheal tube may impinge on the tracheal rings, preventing passage. The goal of this study was to assess insertion difficulty with styletted tubes of different bend angles. METHODS: Tube passage was assessed with four different bend angles (25 degrees, 35 degrees, 45 degrees, and 60 degrees) using straight-to-cuff-shaped tubes...
December 2006: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Giorgio Cozzi, Sara Lega, Rita Giorgi, Egidio Barbi
We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation...
October 5, 2016: Annals of Emergency Medicine
Louise Park, Irene Zeng, Andrew Brainard
OBJECTIVE: Many EDs have begun to evaluate their airway performance. The first-pass success (FPS) rate is a commonly used marker of proficiency, and has been associated with rates of adverse events. The aim of this systematic review and meta-analysis is to quantify the ED FPS rates and summarise the rates of adverse events associated with endotracheal intubation. METHODS: A structured literature search was performed through MEDLINE and EMBASE. Research published since 2000 was included if it prospectively collected data on all patients intubated in the ED and reported the FPS rates...
October 27, 2016: Emergency Medicine Australasia: EMA
Samir Jaber, Marion Monnin, Mehdi Girard, Matthieu Conseil, Moussa Cisse, Julie Carr, Martin Mahul, Jean Marc Delay, Fouad Belafia, Gérald Chanques, Nicolas Molinari, Audrey De Jong
PURPOSE: High-flow nasal cannula oxygen (HFNC) has the potential to provide apnoeic oxygenation. We decided to assess in a proof-of-concept study whether the addition of HFNC to non-invasive ventilation (NIV) could reduce oxygen desaturation during intubation, compared with NIV alone for preoxygenation, in severely hypoxaemic intensive care unit (ICU) patients with respiratory failure. METHODS: We conducted a randomised, controlled, single-centre trial with assessor-blinded outcome assessment in patients admitted to the ICU...
October 11, 2016: Intensive Care Medicine
Rahul Bhat, Maryann Mazer-Amirshahi, Christie Sun, Janelle Vaughns, Maria Dynin, Eshetu Tefera, Daryn Towle, Munish Goyal
OBJECTIVE: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients. METHODS: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011...
September 28, 2016: American Journal of Emergency Medicine
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
John C Sakles, Jarrod Mosier, Asad E Patanwala, John Dicken
INTRODUCTION: Our objective is to evaluate the resident learning curves for direct laryngoscopy (DL) and GlideScope® video laryngoscopy (GVL) over the course of an emergency medicine (EM) residency training program. METHODS: This was an analysis of intubations performed in the emergency department (ED) by EM residents over a seven-year period from July 1, 2007 to June 30, 2014 at an academic ED with 70,000 annual visits. After EM residents perform an intubation in the ED they complete a continuous quality improvement (CQI) form...
November 2014: Western Journal of Emergency Medicine
Dong Hyun Lee, Myongja Han, Ji Young An, Ji Young Jung, Younsuck Koh, Chae-Man Lim, Jin Won Huh, Sang-Bum Hong
AIM: Tracheal intubation during cardiopulmonary resuscitation (CPR) is a high-risk procedure. Here, we investigated the efficacy of video laryngoscopy for tracheal intubation during CPR. METHODS: Data regarding tracheal intubation during CPR from in-hospital cardiac arrests occurring between January 2011 and December 2013 (n=229) were prospectively collected and retrospectively analyzed. RESULTS: The initial laryngoscopy method was video laryngoscopy in 121 patients (52...
April 2015: Resuscitation
Michael J Silverberg, Nan Li, Samuel O Acquah, Pierre D Kory
OBJECTIVES: In the critically ill undergoing urgent endotracheal intubation by direct laryngoscopy, multiple attempts are often required with a higher complication rate due to the urgency, uncontrolled setting, comorbidities, and variability in expertise of operators. We hypothesized that Glidescope video laryngoscopy would be superior to direct laryngoscopy during urgent endotracheal intubation. DESIGN: Single-center prospective randomized controlled trial. SETTING: Beth Israel Medical Center, an 856-bed urban teaching hospital with a 16-bed closed medical ICU...
March 2015: Critical Care Medicine
Yu Sun, Yi Lu, Yan Huang, Hong Jiang
BACKGROUND: We reviewed the updated literature and performed a meta-analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). METHODS: We searched articles published in English matching the key words 'video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)' AND 'direct laryngoscope' AND 'children (including pediatric, infant, neonate)' in PubMed, Ovid, Google Scholar, and the Cochrane Library databases...
October 2014: Paediatric Anaesthesia
Mark Hauswald, Erik K Hauswald
No abstract text is available yet for this article.
September 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
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
Scott D Weingart, Richard M Levitan
Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of primary lung pathology, high metabolic demands, anemia, insufficient respiratory drive, and inability to protect their airway against aspiration. Tracheal intubation is often required before the complete information needed to assess the risk of periprocedural hypoxia is acquired, such as an arterial blood gas level, hemoglobin value, or even a chest radiograph. This article reviews preoxygenation and peri-intubation oxygenation techniques to minimize the risk of critical hypoxia and introduces a risk-stratification approach to emergency tracheal intubation...
March 2012: Annals of Emergency Medicine
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
Jestin N Carlson, Henry E Wang
No abstract text is available yet for this article.
March 2016: Annals of Emergency Medicine
Hao-Chang Chou, Wen-Pin Tseng, Chih-Hung Wang, Matthew Huei-Ming Ma, Hsiu-Po Wang, Pei-Chuan Huang, Shyh-Shyong Sim, Yen-Chen Liao, Shey-Yin Chen, Chiung-Yuan Hsu, Zui-Shen Yen, Wei-Tien Chang, Chien-Hua Huang, Wan-Ching Lien, Shyr-Chyr Chen
OBJECTIVES: This study aimed to assess the diagnostic accuracy and timeliness of using tracheal ultrasound to examine endotracheal tube placement during emergency intubation. METHODS: This was a prospective, observational study, conducted at the emergency department of a national university teaching hospital. Patients received emergency intubation because of impending respiratory failure, cardiac arrest, or severe trauma. The tracheal rapid ultrasound exam (T.R...
October 2011: Resuscitation
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
Calvin A Brown, Aaron E Bair, Daniel J Pallin, Ron M Walls
STUDY OBJECTIVE: We describe the operators, techniques, success, and adverse event rates of adult emergency department (ED) intubation through multicenter prospective surveillance. METHODS: Eighteen EDs in the United States, Canada, and Australia recorded intubation data onto a Web-based data collection tool, with a greater than or equal to 90% reporting compliance requirement. We report proportions with binomial 95% confidence intervals (CIs) and regression, with year as the dependent variable, to model change over time...
April 2015: Annals of Emergency Medicine
Scott D Weingart, N Seth Trueger, Nelson Wong, Joseph Scofi, Neil Singh, Soren S Rudolph
STUDY OBJECTIVE: We investigate a new technique for the emergency airway management of patients with altered mental status preventing adequate preoxygenation. METHODS: This was a prospective, observational, multicenter study of patients whose medical condition led them to impede optimal preintubation preparation because of delirium. A convenience sample of emergency department and ICU patients was enrolled. Patients received a dissociative dose of ketamine, allowing preoxygenation with high-flow nonrebreather mask or noninvasive positive pressure ventilation (NIPPV)...
April 2015: Annals of Emergency Medicine
2015-08-27 19:34:46
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