Annals of emergency medicine
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The inability to correctly position the patient may cause difficulty during oral endotracheal intubation. Examples of such circumstances include cases of suspected cervical spine injury and cases of restricted access to the patient in the prehospital environment. ⋯ The case reported herein, of a successful bougie-assisted oral intubation in the prehospital setting, highlights the usefulness of the technique. Physicians considering the use of the gum elastic bougie for intubation difficulties after rapid sequence induction should seek specific training in the use of the instrument.
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Comparative Study Clinical Trial
Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.
To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). ⋯ The EDD reliably confirms tracheal intubation in the emergency patient population. The EDD is more accurate than ETCO2 monitoring in the overall emergency patient population because of its greater accuracy in cardiac arrest patients. [Bozeman WP, Hexter D, Liang HK, Kelen GD: Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.
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To assess emergency physician knowledge of and effect on clinical practice of the ACEP "Clinical Policy for Management of Adult Patients Presenting With a Chief Complaint of Chest Pain, With No History of Trauma." ⋯ Fewer than half the emergency physicians we surveyed were aware of the policy. Of the physicians who said they had been aware of the policy, most did not know important specifics of the policy.
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We sought to determine whether the interval between the arrival of first responder/defibrillators and paramedic advanced life support (ALS) interventions is associated with outcome. ⋯ Faster response by medics, or any individual ALS intervention other than first-responder defibrillation, demonstrated no benefit in this urban population with short intervals between responder arrivals. Aggressive ALS increased the number of survivors but also decreased their neurologic quality. The benefit of rapid ALS backup to first responder/defibrillators needs further study in other systems. System performance cannot be judged without knowledge of neurologic outcome.