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Baid H, Arora P, Arora RK, Chawang H, Pillai A. Difficult Mask Ventilation in Penetrating Facial Trauma Due to Animal Attack: A Unique Challenge in the Emergency Department. Cureus 2022; 14:e23831. [PMID: 35530820 PMCID: PMC9072267 DOI: 10.7759/cureus.23831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Penetrating facial trauma can be a life-threatening condition, especially due to its impact on the airway. In a facial trauma, there is a distortion in the basic anatomy of the affected, making it a particularly difficult situation for managing the airway. Challenging intubation scenarios have been widely explored in the literature; however, difficult to ventilate situations have been undermined. We describe a case of a 35-year-old female who presented with a history of animal attack on the face. The extent of penetrating facial trauma warranted the need to secure the airway. Preserving spontaneous breathing and using an oral endotracheal tube for oxygenation saved the airway manager from cannot intubate and cannot oxygenate situation in a facial trauma patient. Difficult to mask ventilate while arranging for a definitive airway can be more pressing and challenging for the emergency physician. It also jeopardizes the patient's life, whose survival may only depend on acquiring the patency of the airway. Facial trauma patients may be conscious and spontaneously breathing, leading to the missed or delayed intervention in the airway; hence, prompt assessment and management of the airway in all facial trauma are of utmost importance.
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Bird R, Braunold D, Matava CT. Chest trauma in children-what an anesthesiologist should know. Paediatr Anaesth 2022; 32:340-345. [PMID: 34811835 DOI: 10.1111/pan.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022]
Abstract
Injury is the leading cause of death in children, with chest trauma accounting for 25% of this mortality. In addition, these patients often present with multiple system injuries, which require simultaneous management. These concurrent injuries can lead to challenges when prioritizing tasks in the resuscitation room and during anesthetic management. In addition, changes from spontaneous ventilation to positive pressure ventilation can impact lung physiology. Therefore, a clear communication plan with careful monitoring and vigilance is needed for intubation and ventilation in these children. These injuries also require specific strategies to prevent barotrauma which could lead to complications such as respiratory failure, pneumonia, sepsis, and acute respiratory distress syndrome. This educational review aims to guide clinicians managing pediatric chest trauma through some of the critical decision-making regarding intubation, ventilation, and subsequent management of injuries.
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Affiliation(s)
- Ruth Bird
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Braunold
- Department of Anesthesia, Rambam Medical Center, Haifa, Israel
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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Özerol H, Şancı E, Karakayalı O, Aydın E, Halhallı HC. Selective intubation with endotracheal tube introducer in difficult airway: A randomized, prospective, cross-over study. Turk J Emerg Med 2021; 21:205-209. [PMID: 34849433 PMCID: PMC8593425 DOI: 10.4103/2452-2473.329632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Selective lung intubation is a life-saving procedure in emergency departments. While various equipment can be used in selective lung intubation, most of this equipment is not readily available; therefore, single-lumen endotracheal intubations are performed for rapid interventions. MATERIALS AND METHODS: This study was designed as a randomized, prospective, cross-over study using the 90° rotation technique for selective intubation on a manikin model with and without endotracheal tube introducer (ETI) in difficult airway settings. Forty-six emergency physicians were included in the study. The primary outcome was evaluating time to selective intubations, and secondary outcomes were first and second attempt success rates and the self-perceived difficulty level of each method according to the participants. RESULTS: The mean time to the first successful endotracheal intubation was significantly longer for both right selective and left selective intubations with ETI utilization than without ([39.71 ± 9.83 vs. 21.86 ± 5.94 s], [P < 0.001]), ([42.2 ± 10.81 vs. 26.23 ± 7.97 s], [P < 0.001], respectively). The first-pass success rate did not differ for right selective intubation with or without an ETI (45/46 [97.8%] and 45/46 [97.8%], respectively). However, the first-pass success rate for left selective intubation was significantly higher with ETI as compared to without an ETI (30/46 [65.2%] and 13/46 [28.3%], respectively) (P < 0.001). CONCLUSIONS: While the success rates of right selective intubation were the same, the left selective intubation success rates with ETI are higher than the styletted endotracheal tube, which can be strong evidence for this method's applicability in practice. Expanding the use of ETI and increasing the experience of the practitioners can contribute to further success.
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Affiliation(s)
- Hakan Özerol
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emre Şancı
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Onur Karakayalı
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Erdem Aydın
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hüseyin Cahit Halhallı
- Department of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Root CW, Mitchell OJL, Brown R, Evers CB, Boyle J, Griffin C, West FM, Gomm E, Miles E, McGuire B, Swaminathan A, St George J, Horowitz JM, DuCanto J. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resusc Plus 2020; 1-2:100005. [PMID: 34223292 PMCID: PMC8244406 DOI: 10.1016/j.resplu.2020.100005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/09/2020] [Indexed: 11/25/2022] Open
Abstract
Emergency airway management is often complicated by the presence of blood, emesis or other contaminants in the airway. Traditional airway management education has lacked task-specific training focused on mitigating massive airway contamination. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed in order to address the problem of massive airway contamination both in simulation training and in vivo. We review the evidence describing the dangers associated with airway contamination, and describe the SALAD technique in detail.
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Affiliation(s)
- Christopher W Root
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM, 87106, USA
| | - Oscar J L Mitchell
- Division of Pulmonary, Allergy and Critical Care Medicine and the Center for Resuscitation Science, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19103, USA
| | - Russ Brown
- Southlake Fire Department, 600 State St, Southlake, TX, 76092, USA
| | - Christopher B Evers
- Department of Emergency Medical Services, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY, 11746, USA
| | - Jess Boyle
- School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11746, USA
| | - Cynthia Griffin
- University of Wisconsin Medflight, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Frances Mae West
- Division of Pulmonary, Allergy, and Critical Care Medicine, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Edward Gomm
- Department of Anaesthesia, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
| | - Edward Miles
- Department of Anaesthesia, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK
| | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Anand Swaminathan
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, 703 Main St, Paterson, NJ, 07503, USA
| | - Jonathan St George
- Department of Emergency Medicine, Weill Cornell Medical College, 525 E 68th St, Room M130, New York, NY, 10065, USA
| | - James M Horowitz
- Department of Medicine, New York University Langone Health, 550 1st Avenue, 14th Floor, New York, NY, 10016, USA
| | - James DuCanto
- Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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Lin LW, Huang CC, Ong JR, Chong CF, Wu NY, Hung SW. The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study. Medicine (Baltimore) 2019; 98:e17898. [PMID: 31725637 PMCID: PMC6867733 DOI: 10.1097/md.0000000000017898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 08/01/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022] Open
Abstract
This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.
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Affiliation(s)
- Li-Wei Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
| | | | - Jiann Ruey Ong
- Emergency Department, Shuang-Ho Hospital, New Taipei City
- Department of Emergency Medicine, School of Medicine, Taipei Medical University
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Wen Hung
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
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Application of superior laryngeal nerve block and videolaryngoscope for awake intubation in a patient with severe acute epiglottitis. J Clin Anesth 2018; 54:143-144. [PMID: 30544034 DOI: 10.1016/j.jclinane.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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A simple method for preventing the fog in the videolaryngoscope monitor during awake intubation. J Clin Anesth 2017; 44:84-85. [PMID: 29161545 DOI: 10.1016/j.jclinane.2017.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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Komatsu M, Komasawa N, Yonehara S, Minami T. Efficacy of videolaryngoscope-guided glossopharyngeal nerve block in a patient with severe nasal bleeding. J Clin Anesth 2017; 44:18. [PMID: 29100017 DOI: 10.1016/j.jclinane.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Masaki Komatsu
- Department of Anesthesiology, Osaka Medical College, Japan
| | | | - Shugo Yonehara
- Department of Anesthesiology, Osaka Medical College, Japan
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