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Airway Management

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By Ethan Zook Paramedic
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
Ken Nagao, Hiroshi Nonogi, Naohiro Yonemoto, David F Gaieski, Noritoshi Ito, Morimasa Takayama, Shinichi Shirai, Singo Furuya, Sigemasa Tani, Takeshi Kimura, Keijiro Saku
BACKGROUND: During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. METHODS AND RESULTS: Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation...
April 5, 2016: Circulation
John A Taylor, Corinne Michele Hohl
Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation...
January 2017: CJEM
T Asai
No abstract text is available yet for this article.
March 2016: British Journal of Anaesthesia
Donald E G Griesdale, William R Henderson, Robert S Green
In critically ill patients, endotracheal intubation is associated with a high risk of complications, including severe hypoxemia and hypotension. The purpose of this review is to discuss the definitions, complications, airway assessment, and patient optimization with respect to these patients. In addition, we present different approaches and techniques to help secure the airway in critically ill patients. We also discuss strategies to help minimize the risk of a difficult or failed airway and to mitigate the severe life-threatening complications associated with this high-risk procedure...
June 2011: Lung
G Frova, M Sorbello
Difficult airway management and maintenance of oxygenation remain the two most challenging tasks for anesthetists, while also being controversial items in terms of clinically based-evidence to support relevant guidelines in the literature. Nevertheless, different expert groups and scientific societies from several countries have published guidelines dedicated to the management of difficult airways. These documents have been demonstrated to be useful in reducing airway management related critical accidents, despite their limited use in litigations and legal issues...
April 2009: Minerva Anestesiologica
Henry E Wang, Douglas F Kupas, Mark J Greenwood, Mark E Pinchalk, Terry Mullins, William Gluckman, Thomas A Sweeney, David Hostler
Airway management, including endotracheal intubation, is considered one of the most important aspects of prehospital medical care. This concept paper proposes a systematic algorithm for performing prehospital airway management. The algorithm may be valuable as a tool for ensuring patient safety and reducing errors as well as for training rescuers in airway management.
April 2005: Prehospital Emergency Care
Rani A Sunder, Dawit T Haile, Patrick T Farrell, Anshuman Sharma
Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets...
October 2012: Paediatric Anaesthesia
Cheryl Lynn Horton, Calvin A Brown, Ali S Raja
BACKGROUND: Airway management in a trauma patient can be particularly challenging when both a difficult airway and the need for rapid action collide. The provider must evaluate the trauma patient for airway difficulty, develop an airway management plan, and be willing to act quickly with incomplete information. DISCUSSION: Thorough knowledge of airway management algorithms will assist the emergency physician in providing optimal care and offer a rapid and effective treatment plan...
June 2014: Journal of Emergency Medicine
Jérôme Sudrial, Caroline Birlouez, Anne-Laurette Guillerm, Jean-Luc Sebbah, Roland Amathieu, Gilles Dhonneur
We report a case of prehospital "cannot intubate" and "cannot ventilate" scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device...
2010: Emergency Medicine International
Ernest E Wang, John A Vozenilek, John Flaherty, Morris Kharasch, Pam Aitchison, Abra Berg
Cricothyrotomy is considered an integral procedure in the practice of emergency medicine. The Accreditation Council for Graduate Medical Education requires residents in emergency medicine to demonstrate proficiency in this skill, but because cricothyrotomy is rarely encountered in the clinical setting, alternative methods to teach this high-stakes procedure become an important curricular component in residency training. We present an innovative and inexpensive method for teaching cricothyrotomy using animal trachea and synthetic skin...
2007: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Patrick Schober, Martina C Hegemann, Lothar A Schwarte, Stephan A Loer, Peter Noetges
BACKGROUND: Emergency cricothyrotomy is the final lifesaving option in "cannot intubate-cannot ventilate" situations. Fast, efficient and safe management is indispensable to reestablish oxygenation, thus the quickest, most reliable and safest technique should be used. Several cricothyrotomy techniques exist, which can be grouped into two categories: anatomical-surgical and puncture. METHODS: We studied success rate, tracheal tube insertion time and complications of different techniques, including a novel cricothyrotomy scissors technique in human cadavers...
February 2009: Resuscitation
Ed B G Barnard, Alicia T Ervin, Robert L Mabry, Vikhyat S Bebarta
INTRODUCTION: Airway compromise is the third most common cause of potentially preventable combat death. Surgical cricothyrotomy is an infrequently performed but lifesaving airway intervention. There are limited published data on prehospital cricothyrotomy in civilian or military settings. Our aim was to prospectively describe the survival rate and complications associated with cricothyrotomy performed in the military prehospital and en route setting. METHODS: The Life-Saving Intervention (LSI) study is a prospective, institutional review board-approved, multicenter trial examining LSIs performed in the prehospital combat setting...
2014: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
J B Fortune, D G Judkins, D Scanzaroli, K B McLeod, S B Johnson
OBJECTIVE: The use of surgical cricothyrotomy (SC) in the prehospital setting is controversial, and the need to teach this procedure to paramedics and intermediate emergency medical technicians remains unclear. The purpose of this study is to define the efficacy, complication rate, and overall survival after SC performed in the prehospital setting. METHODS: In our region, emergency medical technicians receive training in this technique using an animal model with bi-annual updates required...
May 1997: Journal of Trauma
M Josephine Hessert, Brad L Bennett
Emergent cricothyrotomy is an infrequently performed procedure used in the direst of circumstances on the most severely injured patients. Austere environments present further unique challenges to effective emergency medical practice. Recently, military trauma registry data were searched for the frequency of cricothyrotomy use and success rates during a 22-month period. These data revealed that cricothyrotomy performed in the most rigorous austere environment (ie, battlefield) had many successes, but also a large number of failed (33%) attempts by medics owing to many factors...
March 2013: Wilderness & Environmental Medicine
David R Wharton, Brad L Bennett
Although the surgical cricothyrotomy procedure is used on combat casualties in the most challenging environments, we are unaware of any published report in the United States of surgical cricothyrotomy performed in a wilderness recreational setting. We describe a 31-year-old male rock climber who fell 24.4 m (80 feet), sustaining serious injuries and requiring rescue from the base of the cliff by a cave/cliff rescue team. Ultimately, a surgical cricothyrotomy proved necessary because of ongoing oropharyngeal bleeding, facial fractures creating an unstable airway, and the need to place the patient in the litter...
March 2013: Wilderness & Environmental Medicine
Kevin T Collopy, Sean M Kivlehan, Scott R Snyder
Managing the airway does not mean intubation, it means managing the airway. Allowing a patient to breathe on their own with appropriate positioning, bag-valve ventilation and blind insertion devices are all airway management options. The surgical cricothyrotomy is a rare and life-saving procedure when managing patients who are in a "can't intubate, can't ventilate" situation. These patients will die without aggressive and rapid intervention. While not all surgical cricothyrotomies provide a definitive airway, the needle cricothyrotomy is an ineffective means for ventilation and its use is discouraged...
January 2015: EMS World
Sobia F Khaja, Matthew J Provenzano, Kristi E Chang
OBJECTIVE: To discuss the role of the King LT reusable supraglottic airway in emergency airway management. DESIGN: Retrospective case series review. SETTING: Tertiary academic medical facility. PATIENTS: We studied patients who presented to the emergency trauma center having undergone intubation at an outside facility or at the scene of the incident. The otolaryngology service was consulted for definitive management of the airway...
October 2010: Archives of Otolaryngology—Head & Neck Surgery
David Lockey, Hans Morten Lossius
No abstract text is available yet for this article.
July 2014: Resuscitation
Daniel E Becker, Morton B Rosenberg, James C Phero
Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Optimizing patient safety using crisis resource management (CRM) involves the entire dental office team being familiar with airway rescue equipment. Basic equipment for oxygenation, ventilation, and airway management is mandated in the majority of US dental offices per state regulations. The immediate availability of this equipment is especially important during the administration of sedation and anesthesia as well as the treatment of medical urgencies/emergencies...
2014: Anesthesia Progress
2016-02-12 16:40:11
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