Air medical journal
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Air medical journal · Mar 2001
Comparative StudyWhat happens with failed blind nasal tracheal intubations?
Flight nurses and paramedics may be called on to perform a blind nasal tracheal intubation (BNTI) as an airway management adjunct. A literature review found two publications addressing air medical BNTI failure rates. No studies examining demographic factors associated with BNTI failure rates nor published reports evaluating the failure rates of subsequent oral tracheal intubation (OTI) and cricothyroidotomy (cric) attempts after failed BNTI were found. This study was undertaken to identify factors associated with BNTI failure and determine the failure rates for OTI and cric performed by flight nurses and paramedics after failed BNTI. ⋯ Flight nurse and flight paramedic teams show a rather low BNTI failure (7%) rate within the confines of the hospital setting but a significantly higher failure rate (48%) when this procedure is performed at the scene of an injury. Although not measured in this study, this difference may represent fewer insertion attempts, less time spent performing BNTI because of the need to rapidly transport trauma patients to appropriate treatment centers, or variation in technique because of the concern for cervical spine injury. Further studies are required to elucidate why differences in scene versus in-hospital BNTI success rates are occurring.
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Air medical journal · Mar 2001
A national survey of the air medical transport of high-risk obstetric patients.
Air medical transport of high-risk obstetric (HROB) patients can be accomplished and advantageous for neonate survival and maternal morbidity. A survey of U.S. helicopter air medical programs was conducted to determine the frequency and current practices of HROB transport. ⋯ While HROBs account for 5% of air medical flights, many programs appear to be poorly prepared for these patients.
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Rapid sequence induction (RSI) for intubation using neuromuscular blockade (NMB) is the most common method of achieving emergent tracheal intubation.(1) The ideal muscle relaxant for RSI would have four characteristics: a rapid onset to minimize the risk of aspiration and hypoxia, a rapid recovery to facilitate the return of ventilation if intubation proves difficult, minimal hemodynamic effects, and minimal systemic effects.(2) However, the ideal drug has yet to be found or created, so succinylcholine has been widely used for more than 40 years as a muscle relaxant in patients with full stomachs or who require emergent intubation.(3,4) Recently, rocuronium has received consideration as an alternative.(1,4) This article discusses both agents.
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Air medical journal · Oct 2000
Comparative StudyPrehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients.
Differences in prehospital resuscitation measures and outcomes of trauma patients transported by two air medical programs were assessed comparing the prehospital administration of crystalloid only (Group A) with the administration of 2 liters of crystalloid followed by blood (Group B). ⋯ Patients with lengthy flight times, despite the administration of blood products, presented to the trauma center more acidotic than trauma patients receiving only crystalloid. The true impact of blood products on outcome could not be demonstrated because of statistical differences in flight times between the groups. A multicenter study matching flight times, head injury status, and flight type of assess benefit of prehospital utilization of blood products is warranted.