J Emerg Med
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Immediate cardiopulmonary resuscitation (CPR) can improve survival rate from cardiac arrest and students are potentially important bystander CPR providers. ⋯ When there is a great desire to learn CPR, the rate and effect of training can be significantly improved by providing students with regular CPR training, especially compression-only CPR training. Training classes should focus on enhancing the participants' confidence. In addition, legislation by the government is needed to protect the rescuers.
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Hanging has become the second most common form of successful suicide in the United States. Along with a high mortality rate, the long-term morbidity is consequential for both the individual patient and society. A thorough knowledge of the clinical approach will assist the emergency physician in providing optimal care and helping to minimize delayed respiratory complications. Using a case-based scenario, the initial management strategies along with rational evidence-based treatments are reviewed.
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Multicenter Study Clinical Trial
Safety and Efficacy of the "Easy Internal Jugular (IJ)": An Approach to Difficult Intravenous Access.
The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown. ⋯ The Easy IJ was inserted successfully in 88% of cases, with a mean time of 4.4 min. Loss of patency, the only complication, occurred in 14% of cases.
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Case Reports
Tracheal Malplacement of the King LT Airway May Be an Important Cause of Prehospital Device Failure.
The King LT airway (King Systems, Noblesville, IN) is a popular extraglottic device that is widely used in the prehospital setting. We report a case of tracheal malplacement of the King airway with a severe kink in the distal tube. ⋯ A 51-year-old unhelmeted motorcyclist collided with a freeway median and was obtunded when paramedics arrived. After bag mask ventilation, a King airway was placed uneventfully and the patient was transported to the emergency department. Because of the concern for an unstable cervical spine injury, a lateral cervical spine radiograph was obtained on arrival. No cervical injury was seen, but the King airway was noted to be malplaced; the King airway passed through the laryngeal inlet and became lodged on the anterior trachea, creating an acute kink between the two balloons. After reviewing the radiograph, ventilations were reassessed and remained adequate. Both balloons were deflated, and the King airway was removed; the patient was orotracheally intubated without complication. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The King airway is a valuable prehospital airway that can be placed quickly and blindly with high success rates by inexperienced providers; the King airway, however, is not without complication. Ventilation was not impaired in this patient, but tracheal malplacement may be an important cause of prehospital device failure. If a first placement attempt of a King airway device fails, it is reasonable to reattempt King airway placement with a new, unkinked device before abandoning King airway placement.