Articles: intubation.
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J. Cardiothorac. Vasc. Anesth. · May 2021
Observational StudyPrediction of Double-Lumen Tube Size By Ultrasonography for Asian Women: A Prospective Observational Study.
To assess the agreement of the diameter of the cricoid cartilage by computed tomography and ultrasonography and to compare the accuracy of the left double-lumen tubes (DLTs) and right DLTs predicted by ultrasonography for Asian women. ⋯ The transverse diameter of the cricoid cartilage in most Asian women can be accurately measured by ultrasonography. The size of the DLT for Asian women can be predicted by ultrasonography measurement of the cricoid diameter.
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The global burden of seizure disorders is apparent and necessitates the effective management of patients with status epilepticus (SE). The goal of management is universally accepted as the prompt mitigation of seizure activity with appropriate supportive care. During management, patients may require intubation. In the process of endotracheal tube placement, patients are administered neuromuscular blockers and general anesthesia. Paralytic activity on the neuromuscular junction hinders the emergency physician's ability to effectively observe seizure activity. Moreover, little can be discerned about patient sedation levels for titration. Effective tourniquet placement may be used to separate a region of the body from general circulation, rendering distal tissues unaffected by neuromuscular blockade. ⋯ A 73-year-old white woman presented to the emergency department with a stroke, and her condition generalized into diffuse tonic-clonic seizures. Concern for airway integrity warranted intubation with appropriate induction of paralysis and sedation. A tourniquet was placed proximal to the right knee and tightened until a dorsalis pedis pulse was no longer palpable. Computed tomography and computed tomography angiography of the head revealed no cerebrovascular event. After imaging, purposeful movements were noted in the right lower extremity distal to the tourniquet despite the initiation of standard dose post-intubation sedation with fentanyl (0.5 μg/kg/h) and propofol (20 μg/kg/min). No tonic-clonic activity was observed. With necessary up-titration, movements ceased. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The observations made support the use of temporally limited tourniquet placement during paralytic administration to assess patient seizure status and sedation levels. Mindful tourniquet use in this manner permits a more effective sedation and management protocol for SE patients coming into the ED and may outweigh the minor risks associated with short-term hypoperfusion.
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Indian J Crit Care Med · May 2021
Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome.
Severe acute respiratory distress syndrome associated with coronavirus disease-2019 (COVID-19) (CARDS) pneumonitis presents a clinical challenge as regards to the timing of intubation and ambiguity of outcome. There is a lack of clear consensus on when to switch patients from trials of noninvasive therapies to invasive mechanical ventilation. We investigated the effect of the timing of intubation from the time of admission on the clinical outcome of CARDS. ⋯ Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021;25(5):493-498.