Der Anaesthesist
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Review Meta Analysis
[Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine : Laryngeal mask is state of the art].
Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. ⋯ Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.
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Being called to a firefighting operation is a rare albeit typical scenario for emergency physicians, which apart from medical expertise requires efficient collaboration with the firefighting team. ⋯ Medical expertise and basic knowledge of methods and tactics employed by the fire service are prerequisites for successful participation as an emergency physician in a firefighting operation. An integrative view of all aspects of injuries of the fire victims and the subsequent therapeutic decisions represent special challenges, which have not yet received much attention in the medical literature.
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Liver failure can be categorized into acute liver failure, chronic liver failure and acute decompensation of chronic liver failure, the so-called acute-on-chronic liver failure, the incidence of which has increased over the last few years. Liver failure leads to a variety of pathophysiological changes where the extent is dependent on the nature and duration of the liver disease. ⋯ Especially chronic liver failure is associated with malfunction of extrahepatic organs, such as the cardiovascular system, the respiratory system and the kidneys. In addition to these pathophysiological alterations the Child-Turcotte-Pugh classification (CTP) and the model of end stage liver disease (MELD) are used for perioperative risk stratification.
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Bystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom's taxonomy). ⋯ Within the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.
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According to the recent guidelines supraglottic airways, such as laryngeal tubes are recommended to ensure oxygenation in patients with unexpected difficult airways. The novel Intubating Laryngeal Tube Suction Disposable (iLTS-D) is a modified laryngeal tube designed for secondary tracheal intubation. This pilot study evaluated the use of the iLTS-D in clinical practice with respect to practicality and efficacy. ⋯ This first clinical study demonstrated that in patients with apparently normal airways and in the hands of users without previous experience, the iLTS-D allowed sufficient ventilation in all patients and had a high success rate for subsequent endotracheal intubation. The results are, however, preliminary until confirmed by further studies, particularly in patients with difficult airways.