Airway management considerations for appendectomy.
Authors: Fabregat-López J, Cook T
PMID: 20186510 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)...
POSTED 02/25/2010 at 06:00 PM --
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Airway management in acute tetraplegics: a retrospective study
The objective of this study was to develop an evidence-based airway management protocol for patients with acute tetraplegia.
The method consisted of an analysis of the medical records of patients (September 1997–December 2002) with a spinal cord injury
and a neurological deficit less than 8 weeks old. Of the 175 patients, 72 (41, 14%) were tracheotomised. This was influenced
by the origin of the paralysis, Frankel score, and number of cervical spine operations, accompanying injuries and accompanying
illnesses. Tracheotomy did not affect the duration of treatment, duration of ventilation or length of stay in the intensive
care unit. The need for a tracheotomy was able to be predicted in 73.31% with neurological level, Frankel score and severity
of accompanying injuries. In pati......
POSTED 02/24/2010 at 12:49 AM --
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Cervical Support Collar: A Substitute to the Jaw Thrust/Chin Lift Methods of Airway Management During Oral Maxillofacial Surgeries
Outpatient single-surgeon–provided intravenous sedation is a safe, cost-effective means of providing anesthesia for numerous oral and maxillofacial surgical procedures. The sedation allows for increased comfort for the patient and can make difficult procedures less stimulating and more routine for patient and surgeon. When sedation is used, it is extremely important that proper airway management techniques are used. Two very basic techniques to maintain airway patency in the sedated patient are the jaw thrust and chin lift methods. The jaw thrust method consists of grasping the angles of the mandible and advancing them forward to increase the opening of the pharynx. The chin lift method consists of advancing the mandible forward by grasping just under the mental protuberance and opening ......
POSTED 02/23/2010 at 08:21 AM --
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Emergency Cricothyrotomy
This article reviews the indications, contraindications, and techniques of surgical and needle cricothyrotomy. Fortunately, with advances in airway techniques and equipment, emergency cricothyrotomy is not a common procedure. However, in the event that a surgeon has no other means of securing an airway, this procedure may avert a catastrophe. If such a situation does occur, quick and decisive action can best be carried out if there is a thorough understanding of the anatomy and techniques involved. (Source: Atlas of the Oral and Maxillofacial Surgery Clinics of North America)...
POSTED 02/23/2010 at 08:19 AM --
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The McKesson prop--an essential tool for the emergency physician?
We describe two patients who suffered multi-system trauma, with severe maxillofacial injuries that necessitated prompt definitive airway management and mid-face stabilisation in the pre-hospital and emergency department phases of resuscitation. The McKesson prop is a simple yet highly effective tool for use in these injuries. (Source: Emergency Medicine Journal)...
POSTED 02/15/2010 at 04:33 AM --
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Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice
Conclusions
The endoscopic dexterity required to proficiently drive a bronchoscope in human subjects to an anatomic endpoint relevant to fibreoptic intubation is achievable after 2–4 h of specialized bench training. Training in the local environment may be more conducive to success than in time-limited workshops. Achieving a defined proficiency standard on bench models contributes to the development of basic bronchoscopic competence. This has the potential to protect patients from novice learning curves, optimize clinical education and efficiency, and assist compliance with difficult airway algorithms. (Source: British Journal of Anaesthesia)...
POSTED 02/11/2010 at 10:36 AM --
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Burns: Learning from the past in order to be fit for the future
Many advances have been made in the understanding and treatment of burns. Advances in burn surgery and critical care have decreased mortality and morbidity. Survival from severe burns is not longer the exception, but unfortunately death still occurs. Williams and colleagues have determined in their recent paper the predominant causes of death in order to develop new treatment avenues and future trajectories suitable to increase survival and overall outcome. A lot of burn deaths may be preventable with better airway management and a more precise and adequate volume management, but the leading cause of death in patients suffering from severe burns, that have to be faced, is sepsis. Sepsis due to multi-drug resistant organisms will continue to impede efforts to increase survival and new stra......
POSTED 02/09/2010 at 06:00 PM --
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A Comparison of Four Techniques of Emergency Transcricoid Oxygenation in a Manikin.
Authors: Salah N, Mhuircheartaigh RN, Hayes N, McCaul C
Cricothyroidotomy is the final rescue maneuver in difficult airway management. We compared 4 techniques of oxygenation via the cricothyroid membrane in a manikin. The techniques were wire guided, trocar, cannula with jet ventilation, and blade technique (scalpel with endotracheal tube). In the wire-guided group, the time taken to ventilation was slower on all attempts, and there were no successful attempts in <40 seconds. There were no differences between the other groups at any time. Time to ventilation improved with repetition in all groups. Skills were retained at 1 month.
PMID: 20142338 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)...
POSTED 02/07/2010 at 06:00 PM --
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[Acute obstructive epiglottitis in intensive care unit: Which airway management strategy?]
We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient.
PMID: 20116197 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)...
POSTED 01/26/2010 at 06:00 PM --
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Delaying Endotracheal Intubation in Less Severely Injured Trauma Patients Increases Mortality
Introduction: Airway management is the number one priority in trauma resuscitation. Patients in cardiopulmonary distress or with airway protection issues clearly need immediate intubation. Despite relatively standard indications for acute post-trauma intubation, there may be a subset of patients who appear clinically stable upon presentation but later deteriorate and require immediate intubation. We sought to determine whether less severely injured patients with delayed intubation have worse outcomes, and to determine any potential risk factors that may predict the need for earlier intubation in this patient population. Our hypothesis was that less severely injured trauma patients with a delay in intubation have higher mortality than those patients intubated earlier with similar injury sev......
POSTED 01/25/2010 at 10:42 AM --
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A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation
This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 [mu]g.kg[minus]1 over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1[ndash]2 [1[ndash]4]) in the dexmedetomidine group and 3 (2[ndash]4 [2[ndash]5]......
POSTED 01/24/2010 at 06:00 PM --
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The author addresses rapid sequence intubation and has created an excellent primer for any provider learning about rapid sequence intubation. The book is easy to understand and generally well written in a conversational style. The material is focused on those providing emergent airway management and is particularly useful for out-of-hospital providers. This is not, nor does it claim to be, a definitive text for airway management. The ideal audiences for this book are providers with some understanding of airway management who are ready to learn about rapid sequence intubation. This includes paramedics, nurses, respiratory therapists, physician trainees and those physicians who practice emergency airway management who may not have had formal training in the technique. (Source: Annals of Emer......
POSTED 01/22/2010 at 08:15 AM --
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Airway management in an infant with double aortic arch
Abstract A 2-month old male was admitted due to repeated cyanotic attacks. He had suffered from stridor and retractive breathing since
birth. Double aortic arch was diagnosed and the vascular ring formed by the double aortic arch was compressing the trachea.
Multirow detector computed tomography showed that he had a right-dominant double aortic arch with left ductus arteriosus and
an aberrant left subclavian artery, and that the narrowest part of the trachea, where the diameter was 2.0 mm, was located
9.0 mm above the carina. Airway management in patients with extreme narrowing of the trachea is challenging for anesthesiologists.
He was scheduled for ligation and division of the left aortic arch and ductus arteriosus. In the operating theater, anesthesia
was slow......
POSTED 01/05/2010 at 11:06 AM --
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Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training
Conclusion:
The FFC is a more realistic and preferred model for direct laryngoscopic orotracheal intubation training. Trucorp and Laerdal manikin can be used as alternative models. (Source: Emergency Medicine Journal)...
POSTED 12/22/2009 at 03:18 PM --
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Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway
Conclusion: The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation. (Source: Resuscitation)...
POSTED 12/20/2009 at 06:00 PM --
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Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes
Conclusion: The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed. (Source: Resuscitation)...
POSTED 12/13/2009 at 06:00 PM --
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The emergency airway.
Authors: Goon SS, Stephens RC, Smith H
The 'can't intubate, can't ventilate' scenario is a nightmare for all clinicians who manage airways. Cricothyroidotomy is one of several emergency airway management techniques. Cricothyroidotomy is a short-term solution which provides oxygenation, not ventilation, and is not a definitive airway.
PMID: 20081629 [PubMed - as supplied by publisher] (Source: British Journal of Hospital Medicine)...
POSTED 12/06/2009 at 06:00 PM --
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Prehospital treatment guidelines in severe traumatic brain injury: What really happens outside the hospital?
The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)≤8. Adherence to these guidelines during prehospital management of severely injured TBI patients has been shown to be associated with reduced morbidity and mortality. In contrast, we reported that 44% of patients with severe TBI were not endotracheally intubated during prehospital trauma care in our urban trauma region. This may be explained by the absence of a physician-based mobile medical team at the trauma scene that is equipped and trained for airway management. From our results we concluded that there is a discrepancy between guidelines and reality in prehospital treatment strategies of severe TBI patients......
POSTED 12/06/2009 at 06:00 PM --
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[Tracheostoma : Handling and complications.]
Authors: Richter T, Sutarski S
Tracheostomy has gained importance due to recent developments in critical care medicine. This procedure is the most frequent surgical intervention on intensive care wards. Indications for tracheostomy (conventional versus dilatational) should consider the duration of the need for a tracheal cannula. The decision for one of the types of tracheostomy may have a relevant impact on the airway management and the rehabilitation of swallowing, because these are dependent on state of the tracheostoma and its subsequent maintenance. Selection of the appropriate cannula helps to avoid complications and improve patient comfort. To minimize the risks during tracheostomy, skills and expertise on the management of life- threatening complications are necessary. Early an......
POSTED 12/02/2009 at 06:00 PM --
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Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy.
Conclusions: Multiple techniques resulted in successful airway control both before and after the induction of general anesthesia. Tracheal intubation was accomplished with both fiberoptic visualization and DL. In instances of poor direct visualization of the glottis, decompression of the airway by opening of the surgical incision may facilitate intubation of the trachea.
PMID: 19955509 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)...
POSTED 12/01/2009 at 06:00 PM --
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