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Measuring the Impact of Time Pressure on Team Task Performance
Published in Rhona Flin, Lucy Mitchell, Safer Surgery, 2009
Colin F. Mackenzie, Shelly A. Jeffcott, Yan Xiao
This chapter examines the impact of time pressure on trauma resuscitation team performance, by using tracheal intubation as a model to contrast task performance at two levels of task urgency, emergency and elective interventions, depending on the clinical circumstances. The task of tracheal intubation is very relevant to understanding anaesthesia activities during surgery, as it is a task carried out after induction of anaesthesia in the operating room. Tracheal intubation includes rendering unconsciousness (using anaesthetic and paralysing drugs if the patient is awake or semi-conscious) to stop breathing efforts or patient resistance and allow placement of an endo-tracheal tube through the mouth and between the vocal cords. The ‘airway management’ achieved by tracheal intubation is a lifesaving intervention when executed correctly in an emergency. However, it requires significant technical skill and has risks (vomiting and aspiration, detrimental changes in vital signs including cardiac arrest) that may even significantly outweigh the potential benefits of improved oxygenation and ventilation. The complications associated with task accomplishment may, themselves, become more life threatening than the problem that the intervention was intended to remedy. Several methods were considered to collect data to examine the impact of time pressure on tracheal intubation.
Outdoor Emissions
Published in William J. Rea, Kalpana D. Patel, Reversibility of Chronic Disease and Hypersensitivity, Volume 4, 2017
William J. Rea, Kalpana D. Patel
According to Cohen and Guzzardi,317 the atmosphere of fire is deadly to breathe. Firefighters or building occupants may be victims of the heat, irritating smoke, depleted oxygen, carbon monoxide, and such other toxic gases as cyanide, hydrogen chloride, and acrolein. Increasing numbers of homes and public building are being built and furnished with highly flammable synthetic materials that give off copious smoke and toxic gases when burned. Whether or not there are cutaneous burns, the possibility of inhalation injury must be considered in any fire victim. All victims of a fire environment should be presumed to have CO intoxication and should be treated with 100% oxygen until the HbCO level is within normal limits. In an extreme situation, cyanide intoxication should be suspected and administration of sodium thiosulfate may be lifesaving. Upper airway occlusion may result from thermal damage or edema secondary to burns from soluble toxic gases. Chemical injury to the lower airway and alveoli may result from inhalation of insoluble irritant gases and toxic gases adsorbed on carbon particles. Upper respiratory tract obstruction may be suggested by the clinical presentation (e.g., pharyngeal burns, stridor, hoarseness, dysphagia), but only by means of fiber-optic bronchoscopy can it be recognized or excluded with certainty. Intubation may be necessary. Lower respiratory tract injury may be manifested clinically by dyspneas, wheezing, and chest tightness, as well as by hypoxemia and reduced FEV(1) and FVC. Treatment is symptomatic, but close observation for progressive respiratory insufficiency is necessary.
Pulmonary complications of blood transfusion
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Patricia M Kopko, Mark A Popovsky
Once the diagnosis of TRALI is entertained, therapeutic measures should be started as quickly as possible. The two key elements in the treatment of TRALI are respiratory support and fluid administration. The respiratory support should be appropriate for the clinical symptoms. In almost all cases, oxygen administration is required.1 Intubation and mechanical ventilation are usually needed in severe cases.
The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review
Published in Expert Review of Medical Devices, 2022
Trias Mahmudiono, Saurabh Singhal, Anas Amer Mohammad, Virgilio E Failoc-Rojas, Maria Jade Catalan Opulencia, Angel Santillán Haro, Yasir Salam Karim, Nizom Qurbonov, Walid Kamal Abdelbasset, Ahmed B. Mahdi, Yasser Fakri Mustafa
Several factors may prolong the time to intubation with aerosol box, such as increased procedural difficulty, experience lack of medical staff, and cognitive overload for the proceduralist [24,25,60]. Although most studies have reported a few seconds difference to intubation with and without the aerosol box, the increases in intubation times did not meet the clinical importance threshold of 10 seconds [30,39]. On the other hand, the COVID-19 infected patients requiring mechanical ventilation may predispose to rapid desaturation and hypoxemia, because their lung function already has drastically impaired [69]; hence, an intubation time difference of several seconds may be significant in these patients. Additionally, most of the data regarding the effect of the aerosol box on intubation time were obtained from simulation studies and it is essential to consider that these studies do not fully capture affecting the human factors can play in real-life circumstances. It has also been reported that difficult airway scenarios represent a greater challenge concerning an increased time to intubation with the aerosol box [24]. In other words, when using the aerosol box in difficult airway scenarios, increase in optimization maneuvers, number of intubation attempts, and failed intubations present more concerns because these factors may more contribute to delay in obtaining intubation [24].