Articles: intubation.
-
Observational Study
Prevalence and predictors of post-intubation hypotension in prehospital trauma care.
Prehospital care of severe trauma patients often involves endotracheal intubation (ETI), which has complications. The frequency and predictors of post-ETI hypotension and cardiac arrest are not well defined in this population. We sought to derive and validate a scoring system that predicts post-ETI hypotension in prehospital patients and to describe the impact of hypotension on outcome. ⋯ Applying our system, 890 (33%) derivation patients and 550 (37%) validation patients were higher risk for post-ETI adverse outcomes. Of these, 21% and 33% respectively experienced post-ETI hypotension and 6% and 4%, respectively suffered post-ETI cardiac arrest. Patients at high risk for post-ETI hypotension or arrest are common and identifiable in prehospital trauma care.
-
Observational Study
Use of the intubating laryngeal mask airway in the emergency department: A ten-year retrospective review.
Extraglottic devices, such as the intubating laryngeal mask airway (ILMA), facilitate ventilation and oxygenation and are useful for emergency airway management, especially as rescue devices. In the operating room setting the ILMA has been highly successful. However, its performance in the ED has not been described. We sought to describe the indications for and success of the ILMA when used in the ED. ⋯ The ILMA was highly successful in oxygenation, with reasonable intubation success, even when used infrequently by emergency physicians. The ILMA should be considered a valuable primary and rescue intubation device in the ED.
-
As a single and reliable parameter for prediction of the difficult airway is missing, the specialist societies for anesthesiology recommend the use of scores that combine the individual parameters. Contemporary scores include head-neck mobility, mouth opening and anatomical distances. Their training and correct performance are essential. ⋯ If the patient reports difficulties with securing the airway in the past, these are likely to occur again if they have not been surgically resolved. This includes an accurate documentation of the airway and knowledge of the in-house standard operating procedure on unexpected difficult airways as well as local equipment. Preparation causes work but may save lives.
-
Case Reports
Prehospital Laryngeal Tube Airway Device Placement Resulting in Hypopharyngeal Perforation: A Case Report.
A 26-year-old female patient presented in cardiac arrest from presumed opioid overdose. An Ambu King LTS-D laryngeal device was placed by EMS providers for airway management during the resuscitation. There was no documented difficulty with placement and breath sounds and waveform capnography were consistent with appropriate placement. ⋯ The case report describes a rare, yet potentially life-threatening, complication of laryngeal tube airway device placement- hypopharyngeal injury. If unrecognized, this injury could lead to serious complications. Providers should be aware of the common and uncommon injuries that are associated with prehospital laryngeal tube airway device placement.