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    Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis.
    J Crit Care 2017 May 8;41:98-106. Epub 2017 May 8.
    Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Via del vespro 129, 90127 Palermo, Italy.
    Purpose: To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation.

    Methods: We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. Read More

    No small matter: pediatric resuscitation.
    Curr Opin Crit Care 2017 Jun;23(3):193-198
    aDepartment of Emergency Medicine, Denver Health Medical Center, Denver, Colorado bDepartment of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado cDepartments of Emergency Medicine, Internal Medicine, School of Public Health and Office of Health System Affairs, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
    Purpose Of Review: To present advancements in pediatric cardiac arrest research, highlighting articles most relevant to clinical practice published since the latest international guidelines for cardiopulmonary resuscitation (CPR).

    Recent Findings: Clinical trials examining targeted temperature management in children support avoidance of hyperthermia for both pediatric in-hospital cardiac arrest (PIHCA) and out-of-hospital cardiac arrest (POHCA), but no statistically significant outcome differences were confirmed comparing 33 and 36 °C in the limited populations studied. Retrospective analyses of population-based POHCA registries revealed several associations: both bystander CPR and public-access defibrillation were associated with improved POHCA outcomes; conflicting results overshadow the benefits of conventional versus compression-only CPR; extracorporeal CPR was associated with improved PIHCA outcomes regardless of cause; intubation in PIHCA was associated with decreased survival, whereas there were no significant differences in outcomes between advanced airway management and bag-valve-mask ventilation in POHCA; and early epinephrine delivery in nonshockable rhythms during PIHCA was associated with improved outcomes. Read More

    Obstructed Infradiaphragmatic Total Anomalous Pulmonary Venous Return in a 13-Day-Old Infant Presenting Acutely to the Emergency Department: A Case Report.
    J Emerg Med 2017 Mar 9. Epub 2017 Mar 9.
    Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.
    Background: Total anomalous pulmonary venous return (TAPVR) is an uncommon congenital heart defect. Obstructed forms are more severe, and typically present earlier in life, usually in the immediate newborn period, with symptoms of severe cyanosis and respiratory failure.

    Case Report: A 13-day-old boy presented to the emergency department (ED) with respiratory extremis. Read More

    Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest.
    Resuscitation 2017 May 4;114:66-72. Epub 2017 Mar 4.
    Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
    Background: Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce.

    Methods: This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. Read More

    Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) - E-C (dominant hand).
    J Cardiovasc Thorac Res 2016 27;8(4):147-151. Epub 2016 Dec 27.
    Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Introduction: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques - E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) - among two novice and experienced groups. Methods: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. Read More

    Respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation.
    Minerva Pediatr 2017 02 7. Epub 2017 Feb 7.
    Pediatric Gastroenterology Unit, Puerta del Mar University Hospital, Cadiz, Spain.
    Background: There is no evidence of the need for oxygen supplementation during upper digestive endoscopies under Ketamine sedation in children, and the latest recommendations specifically state that it is not mandatory for the procedure. The aim of our study is to assess the incidence of respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation when performed without oxygen supplementation, in accordance with the latest recommendations.

    Methods: 88 children undergoingketamine sedation for programmed upper digestive endoscopy at our Pediatric Intensive Care Unit were included. Read More

    Competence in the use of supraglottic airways by Australian surf lifesavers for cardiac arrest ventilation in a manikin.
    Emerg Med Australas 2017 Feb 11;29(1):63-68. Epub 2017 Jan 11.
    Life Saving Victoria, Melbourne, Victoria, Australia.
    Objectives: Lifesavers in Australia are taught to use pocket mask (PM) rescue breathing and bag valve mask (BVM) ventilation, despite evidence that first responders might struggle with these devices. Novices have successfully used the Laryngeal Mask Airway (LMA) Supreme and iGel devices previously, but there has been no previous comparison of the ability to train lifesavers to use the supraglottic airways compared to standard techniques for cardiac arrest ventilation.

    Methods: The study is a prospective educational intervention whereby 113 lifesavers were trained to use the LMA and iGel supraglottic airways. Read More

    Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study.
    Croat Med J 2016 Dec;57(6):591-600
    Anita Lukic, V. Sokola 19, Varazdin, HR42000, Croatia,
    Aim: To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaľdin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management.

    Methods: We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaľdin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician's inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician's turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician's EMS experience. Read More

    Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS.
    BMJ Open 2016 Nov 11;6(11):e012259. Epub 2016 Nov 11.
    Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
    Objective: To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management.

    Methods: We conducted a retrospective cross-sectional medical record review of all 'lights and sirens' emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing. Read More

    Fatal Fentanyl: One Pill Can Kill.
    Acad Emerg Med 2017 Jan 31;24(1):106-113. Epub 2016 Oct 31.
    Veterans Affairs Northern California, Mather, CA.
    Objective: The current national opioid epidemic is a public health emergency. We have identified an outbreak of exaggerated opioid toxicity caused by fentanyl adulterated tablets purchased on the street as hydrocodone/acetaminophen.

    Methods: Over an 8-day period in late March 2016, a total of 18 patients presented to our institution with exaggerated opioid toxicity. Read More

    Apnea After Low-Dose Ketamine Sedation During Attempted Delayed Sequence Intubation.
    Ann Emerg Med 2017 Jan 28;69(1):34-35. Epub 2016 Sep 28.
    Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
    Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. Read More

    Can EMS Providers Provide Appropriate Tidal Volumes in a Simulated Adult-sized Patient with a Pediatric-sized Bag-Valve-Mask?
    Prehosp Emerg Care 2017 Jan-Feb;21(1):74-78. Epub 2016 Oct 3.
    Introduction: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Read More

    Two-Thumb Encircling Technique Over the Head of Patients in the Setting of Lone Rescuer Infant CPR Occurred During Ambulance Transfer: A Crossover Simulation Study.
    Pediatr Emerg Care 2016 Sep 23. Epub 2016 Sep 23.
    From the *Department of Emergency Medicine, School of Medicine, Hallym University, Seoul; and †Department of Emergency Medical Service, Namseoul University, Cheonan City, Choongnam, Republic of Korea.
    Objective: The purpose of this study was to determine if the over-the-head 2-thumb encircling technique (OTTT) provides better overall quality of cardiopulmonary resuscitation compared with conventional 2-finger technique (TFT) for a lone rescuer in the setting of infant cardiac arrest in ambulance.

    Methods: Fifty medical emergency service students were voluntarily recruited to perform lone rescuer infant cardiopulmonary resuscitation for 2 minutes on a manikin simulating a 3-month-old baby in an ambulance. Participants who performed OTTT sat over the head of manikins to compress the chest using a 2-thumb encircling technique and provide bag-valve mask ventilations, whereas those who performed TFT sat at the side of the manikins to compress using 2-fingers and provide pocket-mask ventilations. Read More

    Single rescuer ventilation using a bag-valve mask with internal handle: a randomized crossover trial.
    Am J Emerg Med 2016 Oct 20;34(10):1991-1996. Epub 2016 Jul 20.
    Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX. Electronic address:
    Objective: To compare tidal volume received during single rescuer ventilation with a modified bag-valve mask (BVM) with integrated internal handle vs standard BVM among healthy volunteers using a manikin model.

    Methods: This study was a randomized crossover trial of adult healthcare provider volunteers performing ventilation on a manikin. We randomized participants to perform single rescuer ventilation first using either a modified BVM with integrated internal handle or a standard unmodified BVM. Read More

    Clonidine Overdose in a Toddler Due to Accidental Ingestion of a Compounding Cream.
    Pediatr Emerg Care 2016 Jul 23. Epub 2016 Jul 23.
    From the *William Carey University College of Osteopathic Medicine, Hattiesburg, MS; and Departments of †Pediatric Medicine and ‡Emergency Medicine, Lehigh Valley Health Network, Allentown, PA.
    A 22-month-old girl without any significant medical history accidentally consumed a small amount of a therapeutic compounding cream that contained camphor, gabapentin, clonidine, ketoprofen, and lidocaine. Upon presentation to the emergency department, the child exhibited immediate onset of altered mental status with wide fluctuation in her vital signs, which included intermittent apnea requiring bag-valve mask assistance and endotracheal intubation. Serum laboratory analysis measured a clonidine level of 2. Read More

    Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis.
    BMJ Open 2016 Jun 15;6(6):e011384. Epub 2016 Jun 15.
    Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
    Objective And Design: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Read More

    A comparison of ketamine versus etomidate for procedural sedation for the reduction of large joint dislocations.
    Int J Crit Illn Inj Sci 2016 Apr-Jun;6(2):79-84
    Department of Emergency Medicine, St. Luke's University Hospital, Bethlehem, PA 18015, USA.
    Study Objectives: Ketamine and etomidate are used for procedural sedation (PS) to facilitate the performance of painful procedures. We hypothesized that ketamine produces adequate and comparable sedation conditions for dislocated large joint reduction when compared to etomidate and results in fewer adverse events.

    Methods: This Institutional Review Board approved prospective trial compared a convenience sample of subjects, who were randomized to receive either ketamine or etomidate for PS to facilitate reduction of large joint dislocations. Read More

    Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations?
    Biomed Res Int 2016 16;2016:4521767. Epub 2016 May 16.
    Department of Emergency Medicine & Critical Care, University of Franche-Comté, Medical Centre, 25000 Besançon, France; Monash University, Melbourne, VIC 3800, Australia.
    Introduction. Manikin-based studies for evaluation of ventilation performance show high heterogeneity in the analysis and experimental methods used as we pointed out in previous studies. In this work, we aim to evaluate these potential limitations and propose a new analysis methodology to reliably assess ventilation performance. Read More

    High-Flow Nasal Cannula Versus Bag-Valve-Mask for Preoxygenation Before Intubation in Subjects With Hypoxemic Respiratory Failure.
    Respir Care 2016 Sep 7;61(9):1160-7. Epub 2016 Jun 7.
    Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Background: Critically ill patients with respiratory failure undergoing intubation have an increased risk of hypoxemia-related complications. Delivering oxygen via a high-flow nasal cannula (HFNC) has theoretical advantages and is increasingly used. This study was conducted to compare HFNC with bag-valve-mask (BVM) for preoxygenation and to assess oxygenation during intubation in subjects with hypoxemic respiratory failure. Read More

    Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.
    Resuscitation 2016 Aug 27;105:165-72. Epub 2016 Apr 27.
    Carolinas Medical Center, Charlotte, NC, United States.
    Background: Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown.

    Objectives: To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR. Read More

    Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report).
    J Cardiothorac Surg 2016 Apr 26;11(1):70. Epub 2016 Apr 26.
    Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
    Background: To describe the successful management of a patient with severe dyspnea and hypoxia due to tracheal stenosis by the application of a novel bridging technique-anterograde tracheal catheterization-prior to tracheostomy.

    Case Presentation: A 55-year-old woman entered the Emergency Department with severe dyspnea, tachypnea, and stridor and a pulse oximetry reading of 60 %. An attempt at intubation failed because of tracheal stenosis discovered 3-4 cm distal to the vocal cords, which had been formed as a complication of intubation the previous month. Read More

    Simulation-Based Mastery Learning Improves Medical Student Performance and Retention of Core Clinical Skills.
    Simul Healthc 2016 Jun;11(3):173-80
    From the Department of Emergency Medicine and Medical Education (T.R.), Stritch School of Medicine, Loyola University Chicago; Department of Emergency Medicine (M.P.), Feinberg School of Medicine, Northwestern University; Department of Emergency Medicine (M.M., L.O., S.L.), Stritch School of Medicine, Loyola University Chicago; Department of Informatics (A.E.H.), Center for Simulation Education (D.Q.), and Office of Clinical Research (W.A.), Health Sciences Division, Loyola University Chicago; Department of Neurology and Medical Education (G.G.), Stritch School of Medicine, Loyola University Chicago; and Department of Medical Education (W.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.
    Introduction: Simulation-based mastery learning (SBML) improves procedural skills among medical trainees. We employed an SBML method that includes an asynchronous knowledge acquisition portion and a hands-on skill acquisition portion with simulation to assess senior medical student performance and retention of the following 6 core clinical skills: (a) ultrasound-guided peripheral intravenous placement, (b) basic skin laceration repair, (c) chest compressions, (d) bag-valve mask ventilation, (e) defibrillator management, and (f) code leadership.

    Methods: Seven emergency medicine (EM) faculty members developed curricula, created checklists, and set minimum passing standards (MPSs) to test mastery of the 6 skills. Read More

    Use of a Supraglottic Airway to Relieve Ventilation-Impeding Gastric Insufflation During Emergency Airway Management in an Infant.
    Ann Emerg Med 2016 Oct 13;68(4):452-5. Epub 2016 Apr 13.
    Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN.
    Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ongoing. A 5-week-old female infant required resuscitation for hypoxemic respiratory failure caused by rhinovirus with pneumonia. Read More

    Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.
    Prehosp Emerg Care 2016 Sep-Oct;20(5):578-85. Epub 2016 Mar 17.
    Objective: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. Read More

    Feasibility of a perfused and ventilated cadaveric model for assessment of lifesaving traumatic hemorrhage and airway management skills.
    J Trauma Acute Care Surg 2016 May;80(5):799-804
    From the Simulation Perioperative Resource for Training and Learning (SimPORTAL), University of Minnesota, Minneapolis, Minnesota.
    Background: Training health care providers to manage common life-threatening traumatic injuries is an important endeavor. A fresh perfused cadaveric model with high anatomic and tissue fidelity was developed to assess performance of hemorrhage and airway management skills during a simulated polytrauma scenario.

    Methods: Fresh human cadavers were obtained within 96 hours of death. Read More

    Design and implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART).
    Resuscitation 2016 Apr 2;101:57-64. Epub 2016 Feb 2.
    Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, United States. Electronic address:
    Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-h survival in adult OHCA. Read More

    A case of delayed respiratory depression caused by accidental subcutaneous opioid infusion.
    J Anesth 2016 06 13;30(3):489-92. Epub 2016 Jan 13.
    Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, 650-0017, Japan.
    We report a case of delayed respiratory depression due to accidental subcutaneous opioid infusion. A healthy 33-year-old woman underwent orthopedic surgery under general anesthesia. Before the end of the operation, it was noticed that a part of the opioid infusion had been administered subcutaneously. Read More

    Assessment of Common Preoxygenation Strategies Outside of the Operating Room Environment.
    Acad Emerg Med 2016 Mar 17;23(3):342-6. Epub 2016 Feb 17.
    Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia.
    Objectives: Preoxygenation prior to intubation aims to increase the duration of safe apnea by causing denitrogenation of the functional residual capacity, replacing this volume with a reservoir of oxygen. In the operating room (OR) the criterion standard for preoxygenation is an anesthetic circuit and well-fitting face mask, which provide a high fractional inspired oxygen concentration (FiO2 ). Outside of the OR, various strategies exist to provide preoxygenation. Read More

    Using Near Infrared Spectroscopy for Tissue Oxygenation Monitoring During Procedural Sedation: The Occurrence of Peripheral Tissue Oxygenation Changes With Respiratory Depression and Supportive Airway Measures.
    Acad Emerg Med 2016 Jan 31;23(1):98-101. Epub 2015 Dec 31.
    Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
    Objectives: The objective was to assess whether respiratory depression and supportive airway measures occurring during procedural sedation are associated with changes in peripheral tissue oxygen saturation (StO2 ).

    Methods: This was a prospective observational study of adult patients undergoing procedural sedation in the emergency department (ED). Patients undergoing sedation with propofol, 1:1 propofol and ketamine, and 4:1 propofol and ketamine were included. Read More

    Prehospital airway technique does not influence incidence of ventilator-associated pneumonia in trauma patients.
    J Trauma Acute Care Surg 2016 Feb;80(2):283-8
    From the Departments of Emergency Medicine (M.T.S.) and Surgery (B.R.H.R., D.J.H., A.M., T.A.P.) and the Institute for Military Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
    Background: The relationship between the prehospital airway device used and later development of ventilator-associated pneumonia (VAP) is unknown. We sought to determine if the prehospital airway device choice is associated with an increased risk of VAP in risk-adjusted critically injured patients.

    Methods: We performed a retrospective analysis of all trauma patients requiring definitive airway placement before intensive care unit admission at a Level I trauma center from 2008 to 2012. Read More

    Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.
    Scand J Trauma Resusc Emerg Med 2015 Aug 7;23:57. Epub 2015 Aug 7.
    Norwegian Air Ambulance Foundation, Drøbak, Norway.
    Background: Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.

    Methods: We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. Read More

    Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study.
    Resuscitation 2015 Aug 9;93:113-7. Epub 2015 Jun 9.
    University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France.
    Aim: Supraglottic devices are thought to allow efficient ventilation and continuous chest compressions during cardiac arrest. Therefore, the use of supraglottic devices could increase the chest compression fraction (CCF), a critical determinant of patient survival. The aim of this study was to assess the CCF in out-of-hospital cardiac arrest (OHCA) patients ventilated with a supraglottic device. Read More

    Competency in managing cardiac arrest: A scenario-based evaluation of dental students.
    Acta Odontol Scand 2016 27;74(4):241-9. Epub 2015 May 27.
    b 2 Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg , Erlangen, Germany.
    Objective: Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students' knowledge transfer to an ACLS setting thus remains questionable. Read More

    Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis.
    Resuscitation 2015 Aug 23;93:20-6. Epub 2015 May 23.
    University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA.
    Objective: Overall survival from out-of-hospital cardiac arrest (OHCA) is less than 10%. After initial bag-valve mask ventilation, 80% of patients receive an advanced airway, either by endotracheal intubation (ETI) or placement of a supraglottic airway (SGA). The objective of this meta-analysis was to compare patient outcomes for these two advanced airway methods in OHCA patients treated by Emergency Medical Services (EMS). Read More

    Safety and feasibility of the laryngeal tube when used by EMTs during out-of-hospital cardiac arrest.
    Am J Emerg Med 2015 Aug 29;33(8):1050-5. Epub 2015 Apr 29.
    Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Austrian Red Cross, Vienna, Austria.
    Background: Ventilation is still one key element of advanced life support. Emergency medical technicians (EMTs) without training in advanced airway management usually use bag valve mask ventilation (BVM). Bag valve mask ventilation requires proper training and yet may be difficult and ineffective. Read More

    Airway management techniques in a restricted-access situation: a manikin study.
    Eur J Emerg Med 2016 Aug;23(4):286-291
    aDepartment of Anaesthesia and Critical Care Medicine, Bundeswehr Central Military Hospital, KoblenzbDivision of Medical Biometry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)cDepartment of Anesthesiology, Medical School of the Johannes Gutenberg University, Mainz, Germany.
    Background: Access to patients can be restricted in emergency situations. A variety of techniques and devices are available for use in patients who require oxygenation in a restricted-access situation.

    Objectives: The aim of this study was to investigate whether there is one ventilation technique that is superior to others. Read More

    Feasibility of LMA Supreme for airway management in unconscious patients by ALS paramedics.
    Scand J Trauma Resusc Emerg Med 2015 Feb 26;23:24. Epub 2015 Feb 26.
    Centre for Prehospital Emergency Care, Kuopio University Hospital, PO Box 1777, FI-70210, Kuopio, Finland.
    Background: Airway management to ensure sufficient gas exchange is of major importance in emergency care. The accepted basic technique is to maintain an open airway and perform artificial ventilation in emergency situations is bag-valve mask (BVM) ventilation with manual airway management without airway adjuncts or with an oropharyngeal tube (OPA) only. Endotracheal intubation (ETI) is often referred to as the golden standard of airway management, but is associated with low success rates and significant insertion-related complications when performed by non-anaesthetists. Read More

    The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium.
    Paediatr Anaesth 2015 Jul 27;25(7):689-97. Epub 2015 Mar 27.
    Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Louisville, KY, USA.
    Objectives: To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation.

    Methods: The Pediatric Sedation Research Consortium database of prospectively collected procedural sedation encounters was queried to identify patients for whom body mass index (BMI) could be calculated. Obesity was defined as BMI ≥95th percentile for age and gender. Read More

    Postobstructive pulmonary edema that developed immediately after the removal of an endobronchial foreign body.
    Intern Med 2015 15;54(5):497-502. Epub 2015 Jan 15.
    Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan.
    The patient was a 5-year-old boy who was transported to our hospital for a paroxysmal cough, disturbance of consciousness, tonic-clonic convulsions and labored breathing. The patient's respiratory failure persisted after the convulsions remitted, and the presence of an endobronchial foreign body was suspected based on the findings of chest CT performed the following day. A peanut was subsequently removed from the right main bronchus using a bronchoscope with tracheal intubation and bag valve mask ventilation. Read More

    Preoxygenation reduces desaturation events and improves intubation success.
    Air Med J 2015 Mar-Apr;34(2):82-5
    UC San Diego Emergency Medicine, La Jolla, CA; Kaiser Permanente, San Diego, CA. Electronic address:
    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. Read More

    Out-of-hospital pediatric airway management in the United States.
    Resuscitation 2015 May 25;90:104-10. Epub 2015 Feb 25.
    Department of Emergency Medicine, University of Alabama Birmingham, United States.
    Objective: The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset.

    Methods: In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Read More

    Health care response to CCHF in US soldier and nosocomial transmission to health care providers, Germany, 2009.
    Emerg Infect Dis 2015 Jan;21(1):23-31
    In 2009, a lethal case of Crimean-Congo hemorrhagic fever (CCHF), acquired by a US soldier in Afghanistan, was treated at a medical center in Germany and resulted in nosocomial transmission to 2 health care providers (HCPs). After his arrival at the medical center (day 6 of illness) by aeromedical evacuation, the patient required repetitive bronchoscopies to control severe pulmonary hemorrhage and renal and hepatic dialysis for hepatorenal failure. After showing clinical improvement, the patient died suddenly on day 11 of illness from cerebellar tonsil herniation caused by cerebral/cerebellar edema. Read More

    Outpatient Emergency Preparedness: A Survey of Pediatricians.
    Pediatr Emerg Care 2015 Jul;31(7):493-5
    From the University of Louisville Department of Pediatrics, Louisville, KY.
    Objective: To determine outpatient pediatricians' self-reported experience with and preparation for patient emergencies, and their awareness of the American Academy of Pediatrics (AAP) policy statement on outpatient emergency preparedness.

    Methods: A 34-question cross-sectional survey of outpatient pediatric faculty and gratis faculty from the sole medical school in a metropolitan area was used to assess demographic information, training, and equipment for patient emergencies and familiarity with the AAP policy.

    Results: Of the 57 responses from 123 surveyed physicians (46% response rate), 23% worked in academics and 70% in private practice. Read More

    Pediatric resuscitation training-instruction all at once or spaced over time?
    Resuscitation 2015 Mar 13;88:6-11. Epub 2014 Dec 13.
    McGill Centre for Medical Education, Montreal, QC, Canada; Department of Pediatrics, McGill University, Montreal, QC, Canada; Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada; Arnold and Blema Steinberg Centre for Medical Simulation, Montreal, QC, Canada; Centre for Medical Education, McGill University, Canada; Royal College of Physicians and Surgeons of Canada, Canada.
    Aim: Healthcare providers demonstrate limited retention of knowledge and skills in the months following completion of a resuscitation course. Resuscitation courses are typically taught in a massed format (over 1-2 days) however studies in education psychology have suggested that spacing training may result in improved learning and retention. Our study explored the impact of spaced instruction compared to traditional massed instruction on learner knowledge and pediatric resuscitation skills. Read More

    Over-the-head two-thumb encircling technique as an alternative to the two-finger technique in the in-hospital infant cardiac arrest setting: a randomised crossover simulation study.
    Emerg Med J 2015 Sep 28;32(9):703-7. Epub 2014 Nov 28.
    Department of Emergency Medicine, School of Medicine, Hallym University, Seoul, Republic of Korea.
    Objective: To determine if the over-the-head two-thumb encircling technique (OTTT) provides better quality cardiopulmonary resuscitation (CPR) than the conventional two-finger technique (TFT) when performed by a lone rescuer in an in-hospital infant cardiac arrest setting.

    Methods: This prospective, randomised crossover design study recruited 50 nurses who voluntarily performed lone rescuer infant CPR for 2 min on a manikin. Participants who performed OTTT stood at the head of the manikin to compress the chest and provide bag-valve mask ventilations, whereas those who performed TFT stood by the side of the manikin to compress the chest and provide pocket-mask ventilations. Read More

    Evaluation of a sequential structured educational curriculum for emergency medical technicians in airway management.
    J Anaesthesiol Clin Pharmacol 2014 Oct;30(4):492-5
    Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India.
    Background And Aims: Emergency medical technician (EMT) training programs for certification vary greatly from course to course, but it is necessary that each course at least meets local and national requirements. It is reasonable to expect that EMTs' performance should improve after a structured educational curriculum. We hypothesized that EMTs' performance in airway management would improve after a sequential structured educational curriculum involving airway, followed by cardiopulmonary resuscitation (CPR) modules, beyond what is achieved after only the airway module. Read More

    Hybrid simulation improves medical student procedural confidence during EM clerkship.
    Mil Med 2014 Nov;179(11):1223-7
    Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
    Background: Medical students have limited opportunities to perform and learn procedures on live patients. This is particularly concerning at the Uniformed Services University of the Health Sciences (USUHS), where graduates may be assigned to an operational military unit immediately following completion of internship. The authors implemented a new hybrid simulation lab for fourth-year medical students at the Uniformed Services University of the Health Sciences consisting of procedural skills training for seven core emergency medicine skills combined with complex patient cases using high fidelity simulators and standardized patients. Read More

    Essentials of airway management, oxygenation, and ventilation: part 2: advanced airway devices: supraglottic airways.
    Anesth Prog 2014 ;61(3):113-8
    Professor of Oral Maxillofacial Surgery, Head, Division of Anesthesia and Pain Control, and Associate Professor of Anesthesia, Tufts University Schools of Dental Medicine and Medicine, Boston, Massachusetts.
    Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Part 1 in this series on emergency airway management focused on basic and fundamental considerations for supplying supplemental oxygen to the spontaneously breathing patient and utilizing a bag-valve-mask system including nasopharyngeal and oropharyngeal airways to deliver oxygen under positive pressure to the apneic patient. This article will review the evolution and use of advanced airway devices, specifically supraglottic airways, with the emphasis on the laryngeal mask airway, as the next intervention in difficult airway and ventilation management. Read More

    Air transport of patients with pneumothorax: is tube thoracostomy required before flight?
    Air Med J 2014 Jul-Aug;33(4):152-6
    University of New Mexico Health Science Center.
    Objective: It is conventionally thought that patients with pneumothorax (PTX) require tube thoracostomy (TT) before air medical transport (AMT), especially in unpressurized rotor-wing (RW) aircraft, to prevent deterioration from expansion of the PTX or development of tension PTX. We hypothesize that patients with PTX transported without TT tolerate RW AMT without serious deterioration, as defined by hypotension, hypoxemia, respiratory distress, intubation, bag valve mask ventilation, needle thoracostomy (NT), or cardiac arrest during transport.

    Methods: We conducted a retrospective review of a case-series of trauma patients transported to a single Level 1 trauma center via RW with confirmed PTX and no TT. Read More

    High-fidelity simulation enhances ACLS training.
    Teach Learn Med 2014 ;26(3):266-73
    a Department of Emergency Medicine , University of California , Irvine, Orange , California , USA.
    Background: Medical student training and experience in cardiac arrest situations is limited. Traditional Advanced Cardiac Life Support (ACLS) teaching methods are largely unrealistic with rare personal experience as team leader. Yet Postgraduate Year 1 residents may perform this role shortly after graduation. Read More

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