Annals of emergency medicine
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Review
The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices.
Intubation research on both direct laryngoscopy and alternative intubation devices has focused on laryngeal exposure and not the mechanics of actual endotracheal tube delivery or insertion. Although there are subtleties to tracheal intubation with direct laryngoscopy, the path of tube insertion and the direct line of sight are relatively congruent. With alternative intubation devices, this is not the case. ⋯ With these devices, laryngeal exposure is generally the simple part of the procedure, and conversely, tube delivery to the glottic opening and advancement into the trachea are sometimes not straightforward. This article presents the mechanical and optical complexities of endotracheal tube insertion in both direct laryngoscopy and alternative devices. An understanding of these complexities is critical to facilitate rapid tracheal intubation and to minimize unsuccessful attempts.
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Clinical Trial
Pupillary response to light is preserved in the majority of patients undergoing rapid sequence intubation.
We determine whether pharmacologic neuromuscular blockade with succinylcholine or rocuronium during emergency rapid sequence intubation affects pupillary response to light. ⋯ Succinylcholine and rocuronium do not appear to inhibit pupillary response in patients undergoing emergency department rapid sequence intubation.
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Emergency departments (EDs) face problems with crowding, delays, cost containment, and patient safety. To address these and other problems, EDs increasingly implement an approach called Lean thinking. This study critically reviewed 18 articles describing the implementation of Lean in 15 EDs in the United States, Australia, and Canada. ⋯ Success factors included employee involvement, management support, and preparedness for change. Despite some methodological, practical, and theoretic concerns, Lean appears to offer significant improvement opportunities. Many questions remain about Lean's effects on patient health and employees and how Lean can be best implemented in health care.
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Emergency clinicians often care for patients with terminal illness who are receiving hospice care and many more patients who may be in need of such care. Hospice care has been shown to successfully address the multidimensional aspects of the end-of-life concerns of terminally ill patients: dying with dignity, dying without pain, reducing the burden on family and caregivers, and achieving a home death, when desired. ⋯ Potential poor outcomes include the propagation of misleading or inaccurate information about the hospice system and the failure to guide appropriate patient referrals. This article reviews the hospice care service model and benefits offered, who may qualify for hospice care, common emergency presentations in patients under hospice care, and a stepwise approach to initiating a hospice care referral in the emergency department.
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To date, no German triage tool with proven reliability and validity exists. The goal of this project is to translate and culturally adapt the Emergency Severity Index (ESI) and to assess reliability and validity of the German version. ⋯ Translation of the ESI following guidelines was feasible and resulted in a reliable and valid German version.