What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat

2015 ◽  
Vol 101 (2) ◽  
pp. 155-159
Author(s):  
SJ Mercer ◽  
J Read ◽  
Maj S Sudheer ◽  
JE Risdall ◽  
D Conor
Keyword(s):  
Airway Management ◽  
Complex Trauma ◽  
Case Mix ◽  
Ct Scanner ◽  
Royal Navy ◽  
National Guidelines ◽  
Current Configuration ◽  
Airway Equipment ◽  
Surgical Teams ◽  
Maritime Environment

AbstractThe Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting.

scholarly journals How Well Equipped are ENT Wards for Airway Emergencies?

2006 ◽  
Vol 88 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Rupan Banga ◽  
Andrea Thirlwall ◽  
Rogan Corbridge
Keyword(s):  
Airway Management ◽  
Response Rate ◽  
Telephone Survey ◽  
Junior Doctors ◽  
National Guidelines ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Airway Equipment ◽  
Adequate Provision ◽  
And Training

INTRODUCTION With increased cross cover of specialities at night and more direct triaging of casualty patients to ENT wards, there is an increased need to ensure that there is adequate provision of emergency airway management. There are currently no national guidelines on what equipment should be available on ENT wards, and the authors have devised a portable airway box with all equipment deemed necessary to manage an acute airway. We believe that all junior doctors covering ENT should have airway training and access to an airway box. The aim of this study was to determine the provision of on-ward airway equipment and training on ENT wards in England. MATERIALS AND METHODS A telephone survey of all English hospitals with in-patient ENT services. RESULTS A total of 103 departments were contacted with 98% response rate. Most wards were covered by a combination of ENT and other specialties. Results indicated that only 18% of departments had an airway box and 28% had some training in airway management. CONCLUSIONS Results suggest poor provision of emergency airway equipment and training on wards. We recommend the use of an airway box, and list of minimal equipment required.

scholarly journals Airway Management in the Emergency Department During Coronavirus Disease (COVID-19)

2020 ◽  
Vol 28 (2) ◽  
pp. 5-11
Author(s):  
Sohil Pothiawala
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Viral Infections ◽  
Transmission Risk ◽  
National Guidelines ◽  
Hospital Policy ◽  
Resource Limited ◽  
Increased Risk ◽  
Emerging Viral Diseases ◽  
Evidence Based Guidelines

Front-line health-care workers in the Emergency Department (ED) are at an increased risk of infection during the airway management of patients with known or suspected Emerging Viral Diseases (EVD) like Coronavirus Disease 2019 (COVID-19). The primary route for transmission of the virus from an infected patient to the ED staff is due to aerosolized droplets, and the transmission risk is high despite wearing adequate Personal Protective Equipment (PPE). There are limited evidence-based guidelines for airway management during these viral infections, especially with a focus on the principles of airway management in a busy, fast-paced ED. This article provides an overview of the principles of airway management in suspected or confirmed EVD patients, including COVID-19, particularly in the context of ED, and also considering strategies in resource limited setting. These principles should be adapted to suit your local department and hospital policy on airway management as well as national guidelines.

Perioperative Teamwork for the Patient with a Shared Airway: A Case Study

2017 ◽  
Vol 27 (3) ◽  
pp. 37-43
Author(s):  
G Jones
Keyword(s):  
Airway Management ◽  
Thyroid Surgery ◽  
Perioperative Care ◽  
Essential Element ◽  
Surgical Care ◽  
Airway Surgery ◽  
Surgical Teams

Teamwork is an essential element of perioperative care. Shared airway surgery requires additional considerations for the perioperative team. This article analyses a case study of a patient undergoing thyroid surgery. Whilst the anaesthetic team is responsible for maintaining the patient's airway, the theatre and surgical teams have their own individual roles to assist in airway management and surgical care.

scholarly journals Airway management in critically sick in intensive care

2020 ◽  
Author(s):  
S. K. Malhotra ◽  
Komal Gandhi
Keyword(s):  
Intensive Care ◽  
Airway Management ◽  
Difficult Airway ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operation Theatre ◽  
Physiological Reserve ◽  
Airway Equipment ◽  
One Airway ◽  
Airway Devices

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

Airway Equipment (DRAFT)

2018 ◽  
Author(s):  
Lillian L. Emlet ◽  
James M. Dargin
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Response Team ◽  
Airway Equipment

Patients frequently require airway management during rapid response team (RRT) activations. Airway management during RRT activations frequently occurs in locations that are not well equipped or prepared to perform airway procedures. Therefore, it is important that RRTs arrive with the proper equipment and medications to safely secure the airway whenever necessary. An “airway bag” that is stocked by a hospital’s central supply department and carried by RRTs ensures the availability of functioning equipment and helps to standardize the process of airway management during RRT activation. In this chapter, we will review recommendations for equipment required in emergency airway management, including portable routine and difficult airway equipment and medications.

scholarly journals The Difficult Airway Trolley: A Narrative Review and Practical Guide

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Martin F. Bjurström ◽  
Mikael Bodelsson ◽  
Louise W. Sturesson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Future Research ◽  
Clinical Settings ◽  
Airway Equipment ◽  
National Expert ◽  
Airway Devices ◽  
Facemask Ventilation

Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

P14.31 Between hospital variation in timings to multidisciplinary glioblastoma care in the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii44-ii44
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
Multidisciplinary Treatment ◽  
Case Mix ◽  
National Guidelines ◽  
Tumor Registry ◽  
Hospital Variation ◽  
Long Time ◽  
Newly Diagnosed Glioblastoma ◽  
Brain Tumor Diagnosis

Abstract BACKGROUND Delay in cancer care may adversely affect emotional distress, treatment outcome and survival. Optimal timings in multidisciplinary glioblastoma care are a matter of debate and clear national guidelines only exist for time to neurosurgery. We evaluated the between-hospital variation in timings to neurosurgery and adjuvant radiotherapy and chemotherapy in newly diagnosed glioblastoma patients in the Netherlands. MATERIAL AND METHODS Data were obtained from the nation-wide Dutch Brain Tumor Registry between 2014 and 2018. All adult patients with glioblastoma were included, covering all 18 neurosurgical hospitals, 28 radiotherapy hospitals, and 33 oncology hospitals. Long time-to-surgery (TTS) was defined as >3 weeks from the date of first brain tumor diagnosis to surgery, long time-to-radiotherapy (TTR) as either >4 or >6 weeks after surgery, and long time-to-chemotherapy (TTC) as either >4 or >6 weeks after completion of radiotherapy. Between-hospital variation in standardized rate of long timings was analyzed in funnel plots after case-mix correction. RESULTS A total of 4203 patients were included. Median TTS was 20 days and 52.4% of patients underwent surgery within 3 weeks. Median TTR was 20 days and 24.6% of patients started radiotherapy within 4 weeks and 84.2% within 6 weeks after surgery. Median TTC was 28 days and 62.6% of patients received chemotherapy within 4 weeks and 91.8% within 6 weeks after radiotherapy. After case-mix correction, three (16.7%) neurosurgical hospitals had significantly more patients with longer than expected TTS. Three (10.7%) and one (3.6%) radiotherapy hospitals had significantly more patients with longer than expected TTR for >4 and >6 weeks, respectively. In seven (21.2%) chemotherapy hospitals, significantly less patients with TTC >4 weeks were observed than expected. In four (12.1%) chemotherapy hospitals, significantly more patients with TTC >4 weeks were observed than expected. CONCLUSION Between-hospital variation in timings to multidisciplinary treatment was observed in glioblastoma care in the Netherlands. A substantial percentage of patients experienced timings longer than anticipated.

scholarly journals P088: Procedural sedation in Canadian emergency departments a national survey of airway management, patient monitoring, and adverse events

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S88-S88
Author(s):  
E. Leci ◽  
K. Van Aarsen ◽  
A. Shah ◽  
J. W. Yan
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Clinical Situation ◽  
Procedural Sedation ◽  
Electronic Survey ◽  
Oral Airway ◽  
Canadian Association ◽  
Prolonged Sedation ◽  
Practice Variability ◽  
Airway Equipment

Introduction: Emergency department (ED) physicians strive to provide analgesia, amnesia and sedation for patients undergoing painful procedures through the use of procedural sedation (PS). While, PS is generally safe and effective in the ED, there is institutional variability and clinician disagreement with respect to the bedside equipment required for airway management and the monitoring of adverse events. The primary goal of this research project was to describe the variability of the bedside setup utilized by Canadian ED physicians preforming PS in conjunction with self-reported adverse events. Methods: An electronic survey was distributed through the Canadian Association of Emergency Physicians (CAEP). Practicing physician members of CAEP were invited to complete the survey. The 20 question survey encompassed various aspects of PS including physician choices regarding bedside setup of airway equipment, and prevalence of self-reported adverse events. The primary outcome was the quantification of variability among ED physicians with respect to the above listed aspects of PS. Data was presented with simple descriptive statistics. Results: 278 ED physicians responded to our survey (response rate 20.9%). Respondents were primarily academic (53.2%) or community hospital based (38.2%). With emergency medicine training as: CCFP-EM (55.2%), FRCPC (30.1%), and CCFP (9.0%). The ED area in which PS was carried out varied; bedside (30.5%), procedure room (37.1%), resuscitation area (31.2%). The basic equipment set utilized appears to be a bag valve mask, suction, and an oral airway. These 3 items were present 95.4%, 95.9%, and 86.3% of the time respectively. The preparation of other items such as capnography and difficult airway equipment is highly variable and appears to be physician specific rather than clinical situation specific. The most common physician self-reported adverse events associated with PS appear to be hypoxia (Spo2<90%), hypotension (sBP<90), and prolonged sedation which occurred in 10.7%, 8.3%, and 8.1% of PS performed. Conclusion: There appears to be significant practice variability with respect to the clinical setting as well as the equipment ED physicians prefer when administering PS. Given that causal relationships cannot be inferred between airway/monitoring equipment preferences and adverse events, future studies should be targeted at identifying optimal bedside set ups which minimize adverse events.

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