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Arch Dis Child Fetal Neonatal Ed 2019 Feb 22. Epub 2019 Feb 22.

Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Objective: To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).

Design: Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.

Setting: Ten academic NICUs. Read More

Syst Rev 2019 Jan 24;8(1):32. Epub 2019 Jan 24.

Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.

Background: Emergence coughing and bucking, secondary to endotracheal tube stimulation of the tracheal mucosa, frequently occurs after the general anesthetic recedes. Besides general unpleasantness, coughing has important physiological sequelae that may be detrimental to the postoperative patient. Multiple pharmacological strategies have been published, but prior systematic reviews on this topic have neither been comprehensive enough in their literature or medication search, nor provided us the answer regarding what the best pharmacological method is to prevent or minimize peri-extubation coughing. Read More

BMJ Case Rep 2018 Nov 28;11(1). Epub 2018 Nov 28.

Kettering Hospital, Kettering, UK.

This is the first case in the English language describing in a patient with idiopathic bronchiectasis. A 66-year-old man with bronchiectasis presented with shortness of breath to the emergency department of our institution, a district hospital in the UK. His medications included long-term supplemental oxygen therapy and prophylactic azithromycin. Read More

J Paediatr Child Health 2019 Feb 24;55(2):213-215. Epub 2018 Aug 24.

Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: To demonstrate that unrecognised situation awareness failures events (UNSAFE) transfers are associated with poorer outcomes in the intensive care unit (ICU) at a Japanese children's hospital lacking a rapid response system.

Methods: This retrospective cohort study was conducted between January 2013 and February 2016. UNSAFE transfers were defined as unplanned in-hospital ward-to-ICU transfers requiring tracheal intubation, vasoactive medications or ≥3 fluid boluses before arrival or in the first 60 min of ICU care. Read More

Zhonghua Shao Shang Za Zhi 2018 Jul;34(7):445-449

Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China.

Early airway management and respiratory support are essential for severe inhalation injury. Intratracheal delivery of drugs is better than other methods of administration, because of its higher local drug concentration, faster and more precise effect, and less systemic adverse reactions. It attracts more and more attention at present. Read More

Adv Emerg Nurs J 2018 Jul/Sep;40(3):183-193

Vanderbilt LifeFlight, Vanderbilt School of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee.

Within emergency care settings, rapid sequence intubation (RSI) is frequently used to secure a definitive airway (i.e., endotracheal tube) to provide optimal oxygenation and ventilation in critically ill patients of all ages. Read More

Methods Mol Biol 2018 ;1809:415-429

Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.

Pulmonary delivery in animal models can be performed using either direct administration methods or by passive inhalation. Direct pulmonary delivery requires the animal to be endotracheally intubated, whereas passive delivery uses a nose-only or a whole-body chamber. Endotracheal delivery of therapeutics and vaccines allows investigators to deliver the payload directly into the lung without the limitations associated with passive pulmonary administration methods. Read More

Anaesthesia 2018 Jul 3;73(7):856-862. Epub 2018 May 3.

Welsh Centre for Burns, ABM University Health Board, Swansea, UK.

The i-gel is a supraglottic airway with a gel-like thermoplastic cuff. It has been suggested that the seal around the larynx improves following insertion. Perhaps the most intuitive hypothesis proposed for this is that cuff softening occurs during warming from ambient to body temperature. Read More

Pulm Pharmacol Ther 2018 06 18;50:93-99. Epub 2018 Apr 18.

Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.

Background: Preservative-free tobramycin is commonly used as aerosolized therapy for ventilator associated pneumonia. The comparative delivery profile of the formulations of two different concentrations (100 mg/ml and 40 mg/ml) is unknown. This study aims to evaluate the aerosol characteristics of these tobramycin formulations in a simulated adult mechanical ventilation model. Read More

PLoS One 2018 28;13(3):e0195071. Epub 2018 Mar 28.

Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan.

Introduction: Paraquat poisoning can result in dysfunction of multiple organs, and pulmonary fibrosis with respiratory failure is the major cause of mortality. For terminally ill patients, some life-prolonging treatments can be non-beneficial treatments (NBT). The objective of this study was to determine if intubation is a NBT for patients with respiratory failure due to paraquat poisoning. Read More

Int J Pediatr Otorhinolaryngol 2018 Apr 31;107:45-52. Epub 2018 Jan 31.

Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Electronic address:

Objective: Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Read More

Adv Emerg Nurs J 2017 Oct/Dec;39(4):266-279

Vanderbilt University School of Nursing and Vanderbilt University Medical Center-LifeFlight, Nashville, Tennessee (Dr Gooch); TeamHealth at Maury Regional Medical Center, Columbia, Tennessee (Dr Gooch); Middle Tennessee School of Anesthesia, Madison, Tennessee (Dr Gooch); and Loyola University Chicago Marcella Niehoff School of Nursing, Chicago, Illinois (Dr Roberts).

Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Read More

J Anesth 2017 Dec 25;31(6):878-884. Epub 2017 Oct 25.

Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan.

Purpose: Hypotension and decreased cardiac output (CO) are common adverse effects during anesthesia induction depending on the patient's pre-anesthetic cardiac condition. The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia. Read More

J Antimicrob Chemother 2018 Jan;73(1):143-150

Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA.

Background: Endotracheal tubes provide an abiotic surface on which bacteria and fungi form biofilms, and the release of endotoxins and planktonic organisms can cause damaging inflammation and infections.

Objectives: Ceragenins are small molecule mimics of antimicrobial peptides with broad-spectrum antibacterial and antifungal activity, and a ceragenin may be used to provide antimicrobial protection to the abiotic surface of an endotracheal tube.

Methods: A hydrogel film, containing CSA-131, was generated on endotracheal tubes. Read More

Eur J Pharm Sci 2018 Feb 20;113:145-151. Epub 2017 Sep 20.

Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel. Electronic address:

It is widely acknowledged that inhaled fibers, e.g. air pollutants and anthropogenic particulate matter, hold the ability to deposit deep into the lungs reaching the distal pulmonary acinar airways as a result of their aerodynamic properties; these particles tend to align with the flow and thus stay longer airborne relative to their spherical counterpart, due to higher drag forces that resist sedimentation. Read More

J Trauma Acute Care Surg 2017 10;83(4):569-574

From the Department of Critical Care (R.S.G., M.B.B.), Dalhousie University, Halifax, NS, Canada; and Trauma Nova Scotia, Nova Scotia Department of Health and Wellness (R.S.G., M.E.), Halifax, NS, Canada.

Background: Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in trauma patients and assess the association of PIH with patient outcomes. Read More

Eur J Pharm Sci 2018 Feb 14;113:132-144. Epub 2017 Sep 14.

Computational Sciences Laboratory (UCY-CompSci), Department of Mechanical and Manufacturing Engineering, University of Cyprus, Kallipoleos Avenue 75, Nicosia 1678, Cyprus. Electronic address:

High-fidelity simulations of the complete airway tree are still largely beyond current computational capabilities. Towards large-scale simulations of the human lung, the current study introduces a numerical methodology to predict particle deposition in a simplified approximation of the deep lung during a full breathing cycle. The geometrical model employed consists of an idealised bronchial tree that represents generations 10 to 19 of the conducting zone and a heterogeneous acinar model created using a space-filling algorithm. Read More

Eur J Pharm Sci 2018 Feb 7;113:77-94. Epub 2017 Sep 7.

Department of Mechanical Engineering, Imperial College London, London, UK. Electronic address:

Regional deposition effects are important in the pulmonary delivery of drugs intended for the topical treatment of respiratory ailments. They also play a critical role in the systemic delivery of drugs with limited lung bioavailability. In recent years, significant improvements in the quality of pulmonary imaging have taken place, however the resolution of current imaging modalities remains inadequate for quantifying regional deposition. Read More

Eur J Pharm Sci 2018 Feb 23;113:95-131. Epub 2017 Aug 23.

TU Dresden, Faculty of Medicine Carl Gustav Carus, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring, Fetscherstrasse 74, 01307 Dresden, Germany.

Recent developments in the prediction of local aerosol deposition in human lungs are driven by the fast development of computational simulations. Although such simulations provide results in unbeatable resolution, significant differences among distinct methods of calculation emphasize the need for highly precise experimental data in order to specify boundary conditions and for validation purposes. This paper reviews and critically evaluates available methods for the measurement of single and disperse two-phase flows for the study of respiratory airflow and deposition of inhaled particles, performed both in vivo and in replicas of airways. Read More

J Aerosol Med Pulm Drug Deliv 2018 02 22;31(1):42-48. Epub 2017 Aug 22.

1 Department of Respiratory Care, Texas State University , San Marcos, TX.

Background: Placement of a heat moisture exchanger (HME) between aerosol generator and patient has been associated with greatly reduced drug delivery. The purpose of this study was to evaluate the effect of filtered and nonfiltered HMEs placed between nebulizer and patient on aerosol deposition and airway resistance (Raw) in simulated ventilator-dependent adults.

Methods: An in vitro lung model was developed to simulate a mechanically ventilated adult (Vt 500 mL, RR 15/min, and PEEP 5 cmHO, using two inspiratory flow rates 40 and 50 L/min) using an intubated adult manikin with an endotracheal tube (8 mmID). Read More

J Clin Anesth 2017 11 17;42:53-54. Epub 2017 Aug 17.

Department of Anesthesiology, Radboud UMC, Route 714, P.O. Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address:

Curr Pediatr Rev 2018 ;14(1):9-27

Department of Pediatrics, Schulich School of Medicine, Western University, London, Ontario, Canada.

This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Read More

J Aerosol Med Pulm Drug Deliv 2018 04 16;31(2):94-102. Epub 2017 Aug 16.

Novartis Pharmaceuticals , San Carlos, California.

Background: In an in vitro model of mechanical ventilation with gravity-dependent filter position we observed artificially high delivered doses resulting from liquid droplet collection and precipitation of aerosolized drug. We sequentially modified the model to obtain accurate reproducible measurements of delivered dose and particle size at endotracheal tube exit.

Methods: Stepwise changes in the model included (1) altering the endotracheal tube position to a gravity-independent position, (2) adding fluid traps, (3) humidifying air near the test lung, and (4) simplifying test lung and filters. Read More

J Clin Anesth 2017 09 3;41:71-72. Epub 2017 Jul 3.

Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.

J Clin Anesth 2017 11 1;42:13-14. Epub 2017 Aug 1.

Anesthesiology and Intensive Care, Arrazi Hospital, Mohammed VI Teaching Hospital, Mohammed VI Teaching Hospital, Caddi Ayad University, 40000 Marrakesh, Morocco.

BMC Res Notes 2017 Aug 1;10(1):361. Epub 2017 Aug 1.

Department of Anesthesiology, Intensive Care and Perioperative Medicine, Nepal Medical College (Pvt.) Ltd. Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal.

Background And Objectives: Post-operative airway symptoms can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. In this study, we compared the effectiveness of lubricating an endotracheal tube with betamethasone gel or lidocaine jelly with using an unlubricated tube in reducing the incidence and severity of postoperative sore throat, hoarseness and cough.

Methods: This was a prospective, randomized, single-blind comparative study carried out among 120 ASA I and II patients aged 18-65 years undergoing elective surgery under general anesthesia with endotracheal intubation. Read More

J Emerg Med 2017 Aug 9;53(2):163-171. Epub 2017 Jun 9.

Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, University of Arizona College of Medicine, Tucson, Arizona.

Background: Patients with difficult airways are sometimes encountered in the emergency department (ED), however, there is a little data available regarding their management.

Objectives: To determine the incidence, management, and outcomes of patients with predicted difficult airways in the ED.

Methods: Over the 1-year period from July 1, 2015 to June 30, 2016, data were prospectively collected on all patients intubated in an academic ED. Read More

Toxicol Lett 2017 Aug 1;277:84-91. Epub 2017 Jun 1.

Pomeranian Centre of Toxicology, Gdansk, Poland; Medical University Gdansk, Department of Clinical Toxicology, Gdansk, Poland.

Objective: To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse.

Method: We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes.

Results: We included 710 cases (83% males, mean age 31 years), representing 12. Read More

Clin Microbiol Infect 2017 Sep 13;23(9):629-639. Epub 2017 Apr 13.

Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.

With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Read More

Respir Care 2017 May 7;62(5):538-543. Epub 2017 Mar 7.

Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia 30302-4019.

Background: Many in vitro models report higher inhaled dose with dry versus heated humidity. Heat-and-moisture exchangers (HMEs) provide passive humidity in ventilator-dependent patients but act as a barrier to aerosol. The HMEs designed to allow aerosol delivery (HME-ADs) have not been well described. Read More

Arch Dis Child Fetal Neonatal Ed 2017 May 7;102(3):F277-F281. Epub 2017 Mar 7.

Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.

Many drugs are given to intubated neonates by the inhalation route. The optimum aerosol delivery system, however, has not been identified and there are many challenges in delivering drugs effectively to the lower airways of intubated neonates. The effectiveness of surfactant in prematurely born infants and nitric oxide has been robustly investigated. Read More

South Med J 2017 03;110(3):217-222

From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Objectives: Prescription drug abuse is a major public health problem in the United States, with the rate of opioid-related deaths nearly quadrupling between 2000 and 2014. Extended-release oral oxymorphone hydrochloride (Opana ER) is a long-acting opioid prescribed for chronic pain; however, it also has the potential to be abused via intravenous injection. This retrospective review sought to analyze specific complications and sequelae requiring intensive care unit resources for patients intravenously abusing extended-release oral oxymorphone. Read More

Methods Mol Biol 2017 ;1530:369-378

Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Suite 208, 2705 Frontier Ave NE, Albuquerque, NM, 87106, USA.

This chapter details the intratracheal delivery of dry powder microparticles termed nano-in-microparticles (NIMs) for the purpose of in vivo targeted pulmonary drug delivery. The dry powder NIMs technology improves on previous inhaled chemotherapy platforms designed as liquid formulations. Dry powder microparticles were created through the process of spray drying; a protocol detailing the formulation of NIMs dry powder is included as a separate chapter in this book. Read More

Ann Am Thorac Soc 2017 Apr;14(4):536-542

3 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.

Rationale: Compared with their Full Code counterparts, patients with do not resuscitate/do not intubate (DNR/DNI) status receive fewer interventions and have higher mortality than predicted by clinical characteristics.

Objectives: To assess whether internal medicine residents, the front-line providers for many hospitalized patients, would manage hypothetical patients differently based on code status. We hypothesized respondents would be less likely to provide a variety of interventions to DNR/DNI patients than to Full Code patients. Read More

Ann Card Anaesth 2017 Jan-Mar;20(1):45-51

Cardiovascular Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: This study aimed to test the beneficial effect of grape seed extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary artery bypass surgery.

Patients And Methods: In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surgery included. The patients were randomly assigned into three groups (n = 29 each): (1) Control group with no treatment, (2) GSE group who received the extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C group who received 25 mg/kg Vitamin C through CPB during surgery. Read More

Biomed Res Int 2016 29;2016:4582439. Epub 2016 Nov 29.

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Rheumatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.

. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Read More

Resuscitation 2017 02 14;111:103-109. Epub 2016 Dec 14.

Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia. Electronic address:

Aim: To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA).

Methods: Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2g every 8h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7days of intensive care unit (ICU) stay. Read More

Anaesthesia 2017 Apr 17;72(4):496-503. Epub 2016 Dec 17.

Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.

We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3-13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Read More

Air Med J 2016 Nov - Dec;35(6):371-373. Epub 2016 Oct 24.

Professor, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.

The case presented here highlights an unconventional use of a helicopter emergency medical service (HEMS) to provide a specialized medication to a critically ill patient when definitive transport was delayed. A 39-year-old man presented to a rural hospital 1 hour after sustaining a copperhead envenomation. He developed severe symptoms and was intubated. Read More

Anesth Analg 2016 11;123(5):1302-1306

From the *Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and †Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Background: Spray cryotherapy (SCT) of airway lesions is used to effectively palliate respiratory symptoms related to airway obstruction, but significant intraoperative hemodynamic complications have been noted. We reviewed the experience at a single institution using SCT for the treatment of obstructive airway tumors.

Methods: A retrospective review of a single institution experience with intraoperative and postoperative hemodynamic complications associated with SCT was performed. Read More

J Aerosol Med Pulm Drug Deliv 2017 Apr 18;30(2):100-107. Epub 2016 Oct 18.

1 Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney , Sydney, Australia .

Background: Mechanically ventilated patients commonly suffer from ventilator-associated pneumonia, hypoxemia, and other lower respiratory tract infection as a result of pathogen colonization and poor sputum clearance. Consequently, there is a high rate of morbidity and mortality in these patients. Dry powder mannitol increases sputum clearance, and therefore, we developed a system to administer it to mechanically ventilated patients without disconnection from the ventilator. Read More

Am J Emerg Med 2016 Dec 28;34(12):2423-2425. Epub 2016 Sep 28.

Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC.

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. Read More

Prehosp Disaster Med 2016 Dec 19;31(6):593-602. Epub 2016 Sep 19.

2Department of Emergency Medicine,Hennepin County Medical Center,Minneapolis,MinnesotaUSA.

Background: Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear.

Objective: The goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol. Read More

West J Emerg Med 2016 Sep 26;17(5):542-8. Epub 2016 Jul 26.

Trauma Nova Scotia, Halifax, Nova Scotia, Canada.

Introduction: Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Read More

Zentralbl Chir 2016 Sep 8;141 Suppl 1:S12-7. Epub 2016 Sep 8.

Abteilung für Thoraxchirurgie, Medizinische Universität Wien, Österreich.

Idiopathic subglottic stenosis is a disease characterized by slow, progressive scarring and constriction of the subglottic airway. It almost always occurs in females between the 3rd and 5th decade of life. Symptoms are frequently misinterpreted as asthma and patients are referred for endoscopic evaluation only when asthma medications fail to alleviate their symptoms. Read More

CJEM 2017 May 30;19(3):186-197. Epub 2016 Aug 30.

†Trauma Nova Scotia,Halifax,NS.

Objectives: Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.

Methods: A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. Read More

J Emerg Med 2016 Oct 29;51(4):382-388.e11. Epub 2016 Jul 29.

Section of Medical Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.

Background: Endotracheal intubation remains a cornerstone of early resuscitation of the poisoned patient, but little is known about which substances are associated with intubation.

Objectives: Our objective was to describe patient exposures to substances reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) that were managed with intubation between 2010 and 2014.

Methods: We performed a retrospective review of cases managed with endotracheal intubation in the ACMT ToxIC Registry from January 1, 2010 through December 31, 2014. Read More

Emerg Med Clin North Am 2016 Aug;34(3):453-67

Emergency Medicine, Montefiore/Jacobi Medical Centers, 1400 Pelham Parkway South, Bronx, NY 10461, USA.

The geriatric population makes up a large portion of the emergency patient population. Geriatric patients have less reserve and more comorbid diseases. They are frequently on multiple medications and are more likely to require aggressive treatment during acute illness. Read More