Articles: intubation.
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Retrospective analysis of difficult airway alerts in a major tertiary centre. ⋯ Difficult Airway encounters are an uncommon event in anesthesia, but clear, comprehensive and effectively communicated documentation is required to minimize the risk in future encounters. In our institution, while most difficult airway alerts were appropriate, we found significant heterogeneity in the quality of this documentation, which limits the clinical utility of the alert system. We have taken measures to improve local processes of difficult airway documentation and considered the implications of our project for the broader airway management community.
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Tension pneumoperitoneum (TPP) is a rare but life-threatening pathology in which significant accumulation of free air in the peritoneum pressurizes the abdominal cavity, creating conditions similar to abdominal compartment syndrome. Due to compression of intra-abdominal vasculature, TPP results in hemodynamic instability. While it most commonly occurs due to viscus perforation in the setting of recent endoscopy, gastric perforation from resuscitative efforts can also lead to TPP. ⋯ We present a case of a 58-year-old female who was intubated out-of-hospital for unresponsiveness, then subsequently developed abdominal distension, mottled lower extremities, and hemodynamic instability. In the emergency department, the patient self-extubated for a brief time before suffering cardiac arrest. During resuscitative efforts, imaging showed significant abdominal free air concerning for tension pneumoperitoneum. The likely etiology was positive pressure ventilation after esophageal intubation, resulting in gastric perforation and rapid accumulation of air in the peritoneal cavity. Despite emergent abdominal needle decompression and prompt exploratory surgery, the patient expired. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TPP is a critical pathology that should be on the differential for any patient with recent unverified intubation presenting with hemodynamic instability and abdominal distension. Abdominal needle decompression is a key intervention for the patient with TPP and should be in the emergency physician's skillset. It is also a reminder that intubated patients require confirmation of correct endotracheal tube placement to prevent negative outcomes.
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To conduct a systematic review looking into the use of sevoflurane in the management of status asthmaticus (SA) in adults. ⋯ The systematic review suggests sevoflurane can be a valuable treatment option in SA. As these cases are rare and heterogenous, further prospective case series are needed to support this.
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Airway compromise is the third leading cause of preventable death on the battlefield. Most combat medics carry supraglottic airway (SGA) devices for airway management. However, exchanging an SGA device for a definitive airway can be challenging, especially in austere environments. This study aims to compare the Aintree intubation catheter (AIC) to the gum elastic bougie (GEB) as adjuncts for performing airway device exchange with the i-gel SGA device in place. ⋯ This study demonstrates no significant difference in success rate and time to completion of successful iterations of airway exchanges between the two devices. Although the AIC performed slightly better overall, these results are not statistically significant. Additionally, blind exchange intubations appear to be of high risk with minimal success, so we recommend against this technique in routine practice.