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Bowen AJ, Macielak RJ, Fussell W, Yeakel S, McMillan R, Goates A, Awadallah A, Ekbom DC. Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: Resident and patient experience. Laryngoscope Investig Otolaryngol 2024; 9:e1203. [PMID: 38362188 PMCID: PMC10866581 DOI: 10.1002/lio2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives Single-use rhinolaryngoscopes were brought to market in 2019 as an alternative to traditional reusable scopes and have garnered interest across settings given portability and potential cost advantages. While single-use was previously evaluated compared to traditional devices, the overall impact to the consult experience for both users and patients has not been captured. Methods Eighteen residents performed consults with both single-use and reusable rhinolaryngoscope systems on alternating weeks. A five-question cumulative survey administered across three assessment points over a 12-week period using a five-point rating system to rate favorability. Residents and patients also completed four-point scale surveys following procedure(s) to capture the consult experience. Statistical analyses were performed to measure significance differences between survey responses between the two systems. Results Single-use rhinolaryngoscopes received higher overall ratings compared with reusables across each metric captured including overall consult time (4.3 vs. 2.2, p < .001), multiscope consults (4.4 vs. 3.1, p < .001), patient communication (4.6 vs. 2.1, p < .001), teaching opportunities (4.6 vs. 2.1, p < .001), and overall ease of use (4.7 vs. 2.6, p < .001). Residents rated single-use higher than reusable after each procedure in terms of ease of use (1.07 vs. 2.68, p < .001) and visual clarity (1.27 vs. 1.89, p = .003), while patients rated single-use higher for understanding of illness (3.9 vs. 3.1, p < .001) and understanding of treatment rationale (3.9 vs. 3.1, p < .001). Conclusion Resident and patient experience feedback favored single-use rhinolaryngoscopes compared to reusable scope technology across multiple surveyed measurables. Single-use rhinolaryngoscopes provide a viable tool for otorhinolaryngologist and other clinicians to perform rhinolaryngoscopy consults. Level of Evidence 4.
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Affiliation(s)
- Andrew Jay Bowen
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonUnited States
| | | | - Wanda Fussell
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Sarah Yeakel
- Department of Orthopedic SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Ryan McMillan
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Andrew Goates
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Andrew Awadallah
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Dale C. Ekbom
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
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Maurya I, Maurya VP, Mishra R, Moscote-Salazar LR, Janjua T, Yunus M, Agrawal A. Airway Management of Suspected Traumatic Brain Injury Patients in the Emergency Room. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0042-1760416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractThe patients of trauma offers a special challenge because of the associated head injury, maxillofacial, neck and spine injuries, which puts the airway at imminent risk. The response time for the emergency team to initiate the airway management determines the outcome of the individual undergoing treatment. A judious implementatin of triage and ATLS guidelines are helpful in the allocation of resources in airway management of trauma patients. One must not get distracted with the severity of other organ systems because cerebral tissue permits a low threshold to the hypoxic insults. Adequate preparedness and a team effort result in better airway management and improved outcomes in trauma patients with variable hemodynamic response to resuscitation. All possible efforts must be made to secure a definitive airway (if required) and should be verified clinically as well as with the available adjuncts. The success of a trauma team depends on the familiarity to the airways devices and their discrete application in various situations.
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Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Kalyan Singh Super Specialty Cancer Institute, CG City, Lucknow, Uttar Pradesh, India
| | | | - Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Tariq Janjua
- Department of Critical Care Medicine, Physician Regional Medical Center, Naples, Florida, United States
| | - Mohd Yunus
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Amit Agrawal
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
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Bloom AD, Aliotta RE, Mihas A, Peterson DT, Robinett DA, White ML. Tele-Simulated Instruction and Learner Perceptions of Fiberoptic Intubation and Nasopharyngoscopy: A Pilot Study. West J Emerg Med 2022; 24:104-109. [PMID: 36602496 PMCID: PMC9897257 DOI: 10.5811/westjem.2022.11.58053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Andrew D. Bloom
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Rachel E. Aliotta
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, Alabama
| | - Alexander Mihas
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, Alabama
| | - Dawn Taylor Peterson
- University of Alabama at Birmingham, Department of Medical Education, Birmingham, Alabama
| | - Derek A. Robinett
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Marjorie Lee White
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, Alabama
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Ketamine-Induced Spontaneous Breathing Intubation With Airway Topicalization: A Case Report of Airway Obstruction in Retrieval Care. Air Med J 2022; 41:147-150. [PMID: 35248335 DOI: 10.1016/j.amj.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/28/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
A LifeFlight Retrieval Medicine air medical team was tasked to a rural facility 200 km away to manage and retrieve a 73-year-old woman with evolving airway obstruction. Resources at the referring site included a general practitioner with anesthetic skills training but no access to otorhinolaryngology (ear, nose, and throat) or flexible fiberoptic airway devices. On arrival of the LifeFlight Retrieval Medicine, the patient became agitated, with deterioration in her airway patency. A clinical diagnosis of Ludwig's angina with evolving airway obstruction was made. Using a technique of ketamine-facilitated, spontaneous breathing tracheal intubation with a video laryngoscope, the retrieval team was able to safely secure the patient's airway before transporting her to a regional hospital with ear, nose, and throat surgical services. Computed tomographic imaging revealed an oropharyngeal abscess with spread into the larynx, which subsequently underwent surgical drainage. This case report outlines the technique of awake laryngoscopy with relevance to the retrieval physician and discusses some of the challenges and potential complications associated with it.
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McCloskey CG, Dimza CT, Stull MJ. Peer coaching increases emergency medicine faculty ability to perform and teach awake fiberoptic intubation. AEM EDUCATION AND TRAINING 2021; 5:e10705. [PMID: 34901687 PMCID: PMC8637870 DOI: 10.1002/aet2.10705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study sought to evaluate the impact of peer coaching as a continuing medical education (CME) modality to improve faculty performance and teaching of a low-frequency, high-complexity procedure, awake fiberoptic intubation (AFOI). METHODS Academic emergency medicine faculty at a single tertiary care, Level I trauma center participated in a prospective pre-/postinterventional assessment of a peer coaching educational intervention. Participants completed a preintervention online survey to identify comfort and previous experience with performing and teaching AFOI. The participants reviewed presession materials and then completed a 25-min didactic session with a peer coach. Participants were then broken into dyads where they initially each practiced the procedure and then attempted to teach the procedure to their colleague. An institutional standardized checklist for AFOI was utilized to assess participants procedural competency. Postintervention online surveys were compared to the preintervention surveys. RESULTS A total of 15 faculty members were recruited for the study and completed pre- and postintervention surveys. All participants showed ability to perform AFOI as proven by successful completion of the procedural checklist. There was a statistically significant increase for self-perceived efficacy in performing (p < 0.001, 95% confidence interval [CI] = 1.34 to 3.06) and teaching AFOI (p < 0.001, 95% CI = 1.56 to 3.05). All participants felt more likely to attempt AFOI after a single peer coaching session and most (14/15, 93.3%) were more likely to teach AFOI. Participants identified peer coaching as more effective at instilling confidence to perform and teach the skill than other CME activities that they have experienced. CONCLUSION This study demonstrates that peer coaching increases practicing faculty's ability to perform and teach a low-frequency, high-complexity procedure, AFOI. Peer coaching may offer an opportunity to improve the utility of learning compared to more traditional didactic-based CME initiatives.
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Affiliation(s)
- Colin G. McCloskey
- Departments of Emergency Medicine and AnesthesiologyUniversity Hospitals‐Cleveland Medical CenterClevelandOhioUSA
| | - Christopher T. Dimza
- Health Education CampusCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Matthew J. Stull
- Departments of Emergency Medicine and AnesthesiologyUniversity Hospitals‐Cleveland Medical CenterClevelandOhioUSA
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Kaisler MC, Hyde RJ, Sandefur BJ, Kaji AH, Campbell RL, Driver BE, Brown CA. Awake intubations in the emergency department: A report from the National Emergency Airway Registry. Am J Emerg Med 2021; 49:48-51. [PMID: 34062317 DOI: 10.1016/j.ajem.2021.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe awake intubation practices in the emergency department (ED) and report success, complications, devices used, and rescue techniques using multicenter surveillance. METHODS We analyzed data from the National Emergency Airway Registry (NEAR). Patients with an awake intubation attempt between January 1, 2016 and December 31, 2018 were included. We report univariate descriptive data as proportions with cluster-adjusted 95% confidence intervals (CIs). RESULTS Of 19,071 discrete patient encounters, an awake technique was used on the first attempt in 82 (0.4%) patients. The majority (91%) of first attempts were performed by emergency medicine physicians. Angioedema (32%) and non-angioedema airway obstruction (31%) were the most common indications for an awake intubation attempt. The most common initial device used was a flexible endoscope (78%). Among all awake intubations first-attempt success was achieved in 85% (95% CI [76%-95%]), and peri-intubation complications occurred in 16% (95% CI [9%-26%]). CONCLUSION Awake intubation in this multicenter cohort of emergency department patients was rare and was performed most often in patients with airway edema or obstruction. Emergency physicians performed the majority of first intubation attempts with high first-attempt success. Further studies are needed to determine optimal emergency airway management in this patient population.
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Affiliation(s)
- Maria C Kaisler
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, United States.
| | - Robert J Hyde
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, United States.
| | - Benjamin J Sandefur
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, United States.
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center at the David Geffen School of Medicine at UCLA, 924 Westwood Blvd #300, Los Angeles, CA, 99095, United States.
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, United States.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, 730 S. 8th St, Minneapolis, MN, 55415, United States.
| | - Calvin A Brown
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA, 02215, United States.
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Fink P, Doyle L. Progressive subcutaneous emphysema and compressive optic neuropathy following dental analgesia. J Am Coll Emerg Physicians Open 2020; 1:1278-1280. [PMID: 33392532 PMCID: PMC7771818 DOI: 10.1002/emp2.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Patrick Fink
- Department of SurgeryUniversity of Utah, Division of Emergency MedicineSalt Lake CityUtahUSA
| | - Lisa Doyle
- Department of SurgeryUtah Emergency PhysiciansSalt Lake CityUtahUSA
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Physiologically Difficult Airway in the Patient with Severe Hypotension and Metabolic Acidosis. Case Rep Anesthesiol 2020; 2020:8821827. [PMID: 32953182 PMCID: PMC7487120 DOI: 10.1155/2020/8821827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
The expertise to recognize and manage the difficult airway is essential in anesthesiology. Conventionally, this refers to anatomical concerns causing difficulties with facemask ventilation and/or with tracheal intubation. Severe derangements in patients' physiology can make induction and intubation likewise difficult, and approximately 30% of critically ill patients had cardiovascular collapse subsequently to intubation. We present the case of a 58-year-old male with a past medical history of type II diabetes and hypertension who presented with altered mental status due to severe metabolic acidosis with a pH of 6.8 on admission to the intensive care unit. The anesthesia team was called to urgently intubate the patient. Upon arrival, the patient was localizing to pain and was hypocapnic, tachycardic, and hypotensive despite ongoing therapy with norepinephrine, vasopressin, and bicarbonate drips. Bedside point-of-care ultrasound showed hyperdynamic left ventricle with no other abnormalities. The patient was induced with IV ketamine, and dissociation occurred with maintenance of spontaneous respirations, which was followed by laryngoscopy and intubation causing only minimal hemodynamic changes. The patient was subsequently dialyzed and treated supportively. He was discharged from the hospital two weeks later—neurologically intact and at his baseline. Combination of hypotension and severe metabolic acidosis is particularly a challenging setting for airway management and a major risk factor for adverse events, including cardiopulmonary arrest. Hemodynamically stable induction agents should be preferred. In addition, sustaining spontaneous ventilation and avoiding periods of apnea in the peri-intubation period is paramount—any buildup of CO2 could push a critically low pH even lower and cause cardiovascular collapse. Sympathomimetic properties of ketamine make this induction agent a particularly appealing choice in this setting. This case report further supports the concept that severe physiologic perturbations—in which conventional induction techniques are not feasible—should be included in the current definition of a difficult airway.
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Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases. Indian J Otolaryngol Head Neck Surg 2020; 74:10-17. [PMID: 32904636 PMCID: PMC7457217 DOI: 10.1007/s12070-020-02116-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023] Open
Abstract
To prepare safety protocols for performing videolaryngoscopy (VLS) during COVID-19 pandemic, that would be feasible for patients, hospital and the health care providers. This was a prospective study performed from March 01, 2020 to June 30, 2020. It analyzed the precautions adapted for VLS initially and subsequently describes modifications with the time. The safety protocols are developed considering the safety aspect, the feasibility aspect (due to increase in number of the VLS), and the financial aspect. The VLS was performed with the personal protective equipment (PPE), including the face shield mask and head cover. The PPE was re-used after sterilization with ethylene oxide. For local anesthesia, the oropharynx was sprayed with 15% xylocaine and nose packed with 4% xylocaine soaked pledget. Following the VLS, the scope was wiped three times with 80% alcohol and then immersed in 5.25% sodium hypochlorite and 0.55% ortho-phthalaldehyde for 10 min each. Each VLS was spaced by at least 15 min gap. The endoscopy suite maintained with laminar air flow. It can be concluded that during the COVID-19 pandemic, the VLS must be performed using PPE with proper sterilization of the scope and the endoscopy suite after the procedure. The use of face shield mask and 15% xylocaine spray into the oropharynx were also highlighted. The financial burden should be minimized by reusing the materials whenever possible.
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Sakles JC. Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department. Acad Emerg Med 2017; 24:1395-1404. [PMID: 28791775 DOI: 10.1111/acem.13271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John C. Sakles
- Department of Emergency Medicine; University of Arizona College of Medicine; Tucson AZ
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