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Traumatized Airway
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Edgar J. Pierre, Stephen L. Freiberg, Megan Rashid, Pedro Mascaro
As per the American Society of Anesthesiologist Practice Guidelines for the Management of a Difficult Airway, if a patient cannot be intubated (and cannot be adequately ventilated by facemask), a supraglottic airway (SGA) is indicated [25]. The best studied and most often utilized is the laryngeal mask airway (LMA). If ventilation with the LMA is adequate, the provider has time and options to consider alternative methods of intubation, including but not limited to intubating stylets/exchange catheters, utilizing SGAs as a conduit to intubation, lightwands, or fiberoptic intubation. If ventilation with the LMA is inadequate, this places a provider on the emergency arm of the pathway. In a suggested modified algorithm for the trauma patient, additional adjuncts to be considered if ventilation with an LMA is inadequate, including the esophageal combitube, laryngeal tube, rigid bronchoscope, or transtracheal jet ventilation. Selection between these methods of emergency non-invasive ventilation is far more controversial, and if these methods fail, steps must be taken to obtain an emergency invasive airway.
Iatrogenic tracheobronchial and chest injury
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Marios Froudarakis, Demosthenes Makris, Demosthenes Bouros
Although uncommon and rarely reported, pharyngoeso-phageal perforation following endotracheal intubation may result in severe airway complications that include mediastinitis, retropharyngeal abscess and pneumothorax and pneumonia. Laryngeal masks and Combitubes seem to carry higher risk compared to orotracheal tubes. The use of an intubating laryngeal mask has been reported to result in oesophageal perforation while an endotracheal tube was passed through the mask.83 A retrospective analysis underlined that its use in the pre-hospital setting is associated with a notable incidence of serious complications (20.7 per cent) and complications directly related to trauma from the insertion of the Combitube were estimated as 4.3 per cent.
Prehospital Supraglottic Airways: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John W. Lyng, Kimberly T. Baldino, Darren Braude, Christie Fritz, Juan A. March, Timothy D. Peterson, Allen Yee
In addition to establishing robust training and monitoring performance of EMS clinicians in successfully inserting SGAs, quality management programs should also maintain surveillance for potential complications of SGA use. A case series by Bernhard et al. describes several complications associated with King-style SGAs including airway obstruction due to inadvertent tracheal intubation, massive tongue and pharyngeal edema, air-leak associated hypoventilation, and device obstruction by foreign material (93). Other case reports of SGA-related injuries occurring in the prehospital and surgical settings include hypopharyngeal perforation, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, pneumothorax, upper airway bleeding, esophageal laceration or perforation, and pressure-related tissue injuries of the tongue, pharynx, and hypopharyngeal structures. (47, 94–98). Notably the Combitube has been shown to have up to a 40% complication rate (95–98).
Delayed Sequence Intubation by Intensive Care Flight Paramedics in Victoria, Australia
Published in Prehospital Emergency Care, 2018
Jacinta Waack, Matthew Shepherd, Emily Andrew, Stephen Bernard, Karen Smith
On the other hand, the presence of maxillofacial injuries can complicate RSI, and patients with such injuries have been established as potentially warranting emergency cricothyroidotomy (22, 23). We observed only 7 patients with maxillofacial injury in our cohort and all were successfully intubated. However, Blostein et al. and Davis et al. report on the effectiveness of using alternate rescue airways in these patients, including the esophageal tracheal Combitube (22, 24). In both studies, Combitube insertion was attempted after 2 to 3 RSI attempts. Blostein et al. reported a success rate of 100% and Davis et al. reported 95%. These studies highlight an interesting opportunity to use DSI with rescue airway devices with proven efficacy in facial trauma and warrant further research.
ALS and BLS, an Historical Perspective: Time for a New Paradigm!
Published in Prehospital Emergency Care, 2022
Kristi L. Koenig, David C. Cone
In May 1992, 11 years before the results of the current OPALS study were presented at the Society for Academic Emergency Medicine annual meeting, Dr. Marion Lyver (co-author on the paper) invited several of us who were attending another SAEM meeting in Ontario to a consultation meeting on the future strategy for the Ontario EMS system. The consensus opinion was that the evidence base at the time supported only two out-of-hospital interventions as portending a survival benefit: early defibrillation and advanced airway management. The group’s recommendation was to build a system that included only AEDs and the Combitube as initial out-of-hospital professional skills. Any additional interventions would be studied to prove their benefit prior to implementation as “advanced” skills.