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Bronchoscopy training and simulation for medical education
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Riddhima Agarwal, Emily DeBoer, Tendy Chiang
Shared operating rooms (OR) can be noisy environments where the use of face coverings, especially N-95s and similar respirators, obstructs auditory and visual cues. Thus, communication between the bronchoscopist, anesthesiologist, and OR team should begin outside of the OR. In addition to a surgical time-out, careful discussion of the planned and unplanned operative course will ensure that all teams are appropriately prepared for the procedure. This includes review of anesthesia, airway management, and interventions, as well as developing a course of action for possible complications, incidental findings, and respiratory decompensation. Teaching should similarly occur before, during, and after clinical procedures.
Assessment and recognition of emergencies in acute care
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The urgent response threshold (five or more) is set lower than in the first version of NEWS and is the trigger for urgent review. The RCP urges that a score of five triggers the suspicion of sepsis in those with known/suspected infection or who are at significant risk of infection. The emergency threshold of seven requires not only that the medical team be informed, but for this to be, at least, at specialist registrar level. Review is required by a team with critical care competencies in airway management. A score of seven should prompt the team to consider whether the patient need to be transferred to a higher level of care, or whether the needs of the patient can be met in the current environment. Many patients may respond quickly to timely appropriate interventions, with NEWS 2 falling to a lower trigger level. Those who remain in the emergency threshold after initial treatment, however, are sicker and are likely to require a higher level of care (Level 2 or 3). This may be delivered on the ward, if Level 2 beds and appropriately trained staff are available but will often require transfer to a critical care unit, under the supervision of the critical care team.
Neurosurgery: Functional neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Suparna Bharadwaj, Christine Dy-Valdez, Jason Chui
As direct laryngoscopy is often challenging in patients with a stereotactic frame in a semi-sitting position, an airway management plan should be formulated and the ease of initiating a rescue airway intervention (e.g., bag-mask ventilation or insertion of an LMA) should be assessed at the beginning of the procedure. In our institute, we routinely position the anterior bar front curved piece with its convex side up, two fingerbreadths away from the nasal bridge (Figure 11.2). We found that this frame position allows easy bag-mask ventilation and direct laryngoscopy. A recent mannequin study found that the use of LMA and video laryngoscopy achieved higher successful first attempts than direct laryngoscopy (97% for both vs. 93%) in the setting of a stereotactic head frame. The average time of securing the airway device was faster for LMA than intubation with video laryngoscopy (35 sec vs. 55 sec) (22). However, in some cases the airway can only be secured with fiberoptic intubation or after removing the stereotactic frame emergently.
Suspected tetanus in an unvaccinated pediatric patient
Published in Baylor University Medical Center Proceedings, 2023
Kimberly Walter, Renita Thomas, Swasti Gyawali, Sowmya Kallur
Extubation was attempted on hospital day 9 with initial success. On day 11 of admission, respiratory failure worsened significantly, requiring emergent reintubation. Two hours after reintubation, the patient developed significant hypoxia and bradycardia after bag suctioning. He developed a left tension pneumothorax secondary to high peak inspiratory pressure and was treated with needle decompression and thoracentesis. After the chest tube was placed, the patient had a code event requiring one round of compressions. Two hours after this event, he had an additional code event requiring two rounds of compression and a dose of epinephrine before return of spontaneous circulation. His respiratory status began to stabilize, and sedation was gradually weaned. Tracheotomy was performed on hospital day 16 for airway management.
Prehospital Airway Management Training and Education: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Maia Dorsett, Ashish R. Panchal, Christopher Stephens, Andra Farcas, William Leggio, Christopher Galton, Rickquel Tripp, Tom Grawey
The affective domain of learning encompasses a clinician’s values and motivations and thus has a critical role to play in the development of competence in airway management. (65). Our goal in airway management education is for our learners to internalize the value of patient outcome over procedural success in such a way that it influences their behavior in the course of patient care. In many EMS programs, the assessment of affective domain focuses on the student’s attitude toward class (did you dress professionally and try your best?) and bedside manner during simulated and real-life patient interactions. While professionalism and empathy toward the patient are important facets of EMS clinical care, closer analysis of values and attitudes toward procedural skills is often an overlooked feature of the affective learning domain. An EMS clinician skillful in the affective domain is an advocate for quality patient care and patient care systems while making patient care decisions with the patient at the center (66). Affective domain in airway management applies most to the values and patient empathy considered when managing the airway. While the cognitive aspect is knowing the appropriate way to manage an airway, the affective domain highlights the decision to perform this intervention based on the balance between airway knowledge and what an individual values regarding the procedure. Clinicians should be taught that endotracheal intubation is just one of many tools for achieving airway management and should only be used when likely to improve patient outcome.
Prehospital Trauma Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Sabina Braithwaite, Christopher Stephens, Kyle Remick, Whitney Barrett, Francis X. Guyette, Michael Levy, Christopher Colwell
Prehospital advanced trauma airway management includes several low-frequency, high-consequence procedures, while mastery of basic trauma airway assessment and management is a foundational skill needed for every patient. Appropriate prioritization of airway management within the larger context of the patient, clinician, and environmental considerations drives the choice of necessary airway interventions. Decisions on airway management in trauma patients should be targeted toward achieving specific resuscitation goals to maintain focus on achieving the best patient outcomes rather than on the performance of specific procedures. Airway management failures account for 8 to 15% of potentially preventable trauma deaths (1–4). As such, medical director involvement in the assurance of EMS clinician initial and ongoing competency in procedural skills and in critical decision-making are core elements of quality prehospital trauma airway management.