The American journal of emergency medicine
-
Randomized Controlled Trial
Comparison of the Macintosh laryngoscope and blind intubation via the iGEL for intubation with cervical spine immobilization: A randomized, crossover, manikin trial.
Endotracheal intubation (ETI) using a Macintosh laryngoscope (MAC) requires the head to be positioned in a modified Jackson position, slightly reclined and elevated. Intubation of trauma patients with an injured neck or spine is therefore difficult, since the neck usually cannot be turned or is already immobilized in order to prevent further injury. The iGEL supraglottic airway seems optimal for such conditions due to its blind insertion without the need of a modified Jackson position. ⋯ We showed that blind intubation with the iGEL supraglottic airway was superior to ETI performed by paramedics in a simulated cervical immobilization scenario in a manikin in terms of success rate, time to definite tube placement, head extension angle, tooth compression, and rating.
-
Comparative Study
Use of radiography and ultrasonography for nasal fracture identification in children under 18 years of age presenting to the emergency department.
To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma. ⋯ We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation.
-
Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. ⋯ Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission.