Articles: intubation.
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Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. ⋯ A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.
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There are few data available regarding the emergency department practice of using recently dead patients (RDP) for practice and training in endotracheal intubation (ETI/RDP). We investigated several aspects of practice by means of a survey sent to all 5,397 emergency departments in the country. Of the 992 (18.3%) responses, 537 (54.1%) did practice ETI/RDP; 455 (45.8%) did not (P less than 0.005). ⋯ There was widespread agreement as to the educational value of the practice, although it was more favored in hospitals practicing ETI/RDP than those that do not: 411 of 418 (98%) hospitals practicing ETI/RDP agreed that it was an important component of medical education, as did 240 (80%) of institutions not practicing it (P less than 0.0001). Nearly equal percentages of teaching hospitals (53.8%) and nonteaching facilities (57.9%) engage in ETI/RDP (P = 0.35). Objections to ETI/RDP had been noted in 25% of the institutions where it was practiced.