China
Africa
Explore chapters and articles related to this topic
The injured child
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Airway obstruction will require immediate resolution and possibly advanced airway management. This should be performed by clinicians competent in paediatric advanced airway management (see Chapter 15). Basic airway management can be tricky, in particular for infants, since small movements can obstruct the airway and constant vigilance and repositioning is required. Maintaining an airway in order to provide bag–valve–mask (BVM) ventilation with the two-person technique is particularly useful in children. Appropriately sized airway adjuncts must be carried to assist in basic airway management.
Recent advances in anesthesia for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Haley Reis, Onat Akyol, Vadim Gospodarev, Cesar Reis, Gocke Yilmaz, Richard Applegate, Sheng Chen, John Zhang
Preventing cerebral herniation through careful monitoring of ICP in TBI patients is of the utmost importance, but there is also a clear association between brain tissue hypoxia and poor outcomes in this patient population.46 TBI, in isolation, is associated with significant neuroinflammation; however, a study conducted by Yan and colleagues revealed that the neuroinflammatory state is further exacerbated by hypoxia, which has been shown to enhance cerebral cytokine production and unfavorable outcomes in TBI patients47 (Figure 35.1). The preliminary results of an ongoing Excellence in Prehospital Injury Care (EPIC) study recommends maintaining patient oxygen saturation levels above 90%, as lower oxygenation levels have been shown to significantly increase TBI-associated mortality.48 An obvious way to prevent brain tissue hypoxia in TBI patients is through airway management. However, there is an ongoing debate on whether endotracheal intubation is superior to basic airway management based on widely varying study findings, with some even pointing to an increased mortality in TBI patients that underwent intubation.49 At this point in time, TBI patient outcomes following intubation vary based on the severity of TBI and other factors, such as use of sedatives, but it mainly comes down to experience of individuals performing the intubation; basic airway care performed properly results in significantly more favorable patient outcomes than a botched intubation.50,51
Answers
Published in John D Firth, Professor Ian Gilmore, MRCP Part 2 Self-Assessment, 2018
John D Firth, Professor Ian Gilmore
The first step in basic airway management is to open the airway. This should be done with a head-tilt chin lift, unless there is suggestion of a neck injury when a jaw-thrust manoeuvre is preferred. Material in the oropharynx should be removed under direct vision. Oropharyngeal (OPA) and nasopharyngeal (NPA) airways are useful adjuncts but do not provide a definitive airway for unconscious patients.
Are Pediatric Manual Resuscitators Only Fit for Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance
Published in Prehospital Emergency Care, 2023
Gregory Sun, Susan Wojcik, Jennifer Noce, Nicholas Cochran-Caggiano, Tracie DeSantis, Steven Friedman, Derek R. Cooney, Chrisitan Knutsen
Lastly, results were broken down by certification level. EMTs are often called upon to assist with manual resuscitator ventilations while the paramedic performs additional interventions (15). Because of this, and the varied training for each clinician, it is important to assess not only the paramedic but also the EMT as both are expected to deliver adequate ventilations. It was noted that the EMTs were consistent in delivering 50% less volume than that of their paramedic counterparts. Average differences ranged from 112 ml to 249 mL, indicating a sizable and presumably clinically significant difference. These data correlated with the general observations made by the principal author while conducting the trial. To affirm these findings, the principal author ventilated the manikin after each EMT completed the trial in order to determine if there was any defect or air leak, though none were found. A potentially related finding in a study by Kurz et al. was a greater return of spontaneous circulation rate in out-of-hospital cardiac arrest cases when advanced life support clinicians were present earlier along with basic life support clinicians, implying a difference in performance (16). Further study to investigate differences in basic airway management and other elements of initial resuscitation care by advanced and basic life support clinicians is warranted.
Assessing clinical reasoning in airway related cases among anesthesiology fellow residents using Script Concordance Test (SCT)
Published in Medical Education Online, 2022
Andy Omega, Andi Ade Wijaya Ramlan, Ratna Farida Soenarto, Aldy Heriwardito, Adhrie Sugiarto
During their residency, residents were trained for airway management according to their level of training and must be qualified before proceeding to the next level. ‘Junior’ residents received basic airway management training and they could perform basic airway management under the direct supervision of an anesthesiology consultants. After passing the basic airway management theory examination, they will reach intermediate level of residency. ‘Intermediate’ residents were allowed to perform basic airway management with minimal supervision, but they were only allowed to perform difficult airway management under the direct supervision of the anesthesiology consultants. Intermediate residents will have to pass the practical examination of basic airway management and the difficult airway theory examination before proceeding to the next level. ‘Senior’ residents were deemed capable of performing basic airway management without any supervision but still needed to report to an anesthesiologist consultant before and after the procedure. For difficult airway management, they were only allowed to perform procedures under supervision. Difficult airway management that was trained in our residency program includes the use of video laryngoscope, fibreoptic and surgical airway management.
Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS)
Published in Prehospital Emergency Care, 2022
Sattha Riyapan, Jirayu Chantanakomes, Bongkot Somboonkul, Sang Do Shin, Wen-Chu Chiang
The primary outcome of this study was survival in the ED compared between the nighttime and daytime groups. Survival in the ED was defined from ED disposition status as RTI patients survived to discharge from ED, survived to refer to another hospital, or survived to admit to inpatient. Survival to discharge was extracted from the hospital discharge status, which included the patients who were treated in the hospital and then discharged or transferred to another healthcare facility. We also compared prehospital interventions, including basic airway management, advanced airway management, oxygen supplementation, and total immobilization. Basic airway management included oropharyngeal or nasopharyngeal airway insertion. Advanced airway management consisted of endotracheal intubation or supraglottic airway insertion. Oxygen supplementation comprised nasal canula, face mask, or bag valve mask ventilation. Total immobilization included C-spine or spinal immobilization, femur traction or immobilization, and bandaging at an active bleeding area. The study identified characteristics of RTI patients at night. Alcohol use and substance abuse data was from both biologic evidence and physician’s report. Low- and middle-income countries were grouped according to the World Bank, such as Thailand, Vietnam, India, and Malaysia (see https://data.worldbank.org/income-level/low-and-middle-income).