Articles: intubation.
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Prehosp Disaster Med · Aug 2020
A Positive-Pressure Environment Disposable Shield (PEDS) for COVID-19 Health Care Worker Protection.
The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. ⋯ The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.
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The American surgeon · Aug 2020
Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the "ABC" Algorithm When Time Is of the Essence?
There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the "ABC" algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. ⋯ Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional "ABC" algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.
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Enteral feeding, mainly by using a nasogastric tube (NGT), is generally favored over parenteral supplementation in head and neck cancer (HNC) patients with dysphagia. However, the placement of a NGT, either blindly or by endoscopy, is technically challenging in these patients due to the obstructive mass and the altered regional anatomy. The aim of this retrospective study was to estimate the clinical feasibility and safety of fluoroscopic-guided NGT placement in patients with advanced HNC. ⋯ Our results show that fluoroscopic-guided NGT placement is a highly safe and effective procedure for patients with advanced HNC requiring enteral feeding.
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Eur Arch Otorhinolaryngol · Aug 2020
ReviewRecommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic.
The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure. ⋯ In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
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Journal of anesthesia · Aug 2020
Observational StudySummary of 20 tracheal intubation by anesthesiologists for patients with severe COVID-19 pneumonia: retrospective case series.
SARS-CoV-2 pandemic is announced and it is very important to share our experience to the critical care community in the early stage. Urgent intubation team was organized by anesthesiologists and was dispatched upon request. We have retrospectively reviewed medical charts of 20 critically ill patients with Covid-19 pneumonia who required tracheal intubation from February 17 to March 19 in Wuhan No.1 hospital, China. ⋯ Although intubation improved SPO2, reduced PaCO2 and blood lactate, seven of 20 patients died within 7-days after tracheal intubation. Non-survivors showed significantly lower SPO2 and higher PaCO2 and blood lactate compared to survivors. For those who are anticipated to deteriorate severe pneumonia with poor prognosis, earlier respiratory support with tracheal intubation may be advised to improve outcome.