Airway Management In The Emergency Department

2018 ◽  
Author(s):  
Garrett S. Pacheco ◽  
Bryan Wilson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Airway Emergency ◽  
Rapid Sequence ◽  
First Pass ◽  
Surgical Airway

Emergency airway management has evolved tremendously since the onset of the specialty’s origin. Over the years, the importance of first-pass success and approach to the difficult airway were the primary challenges faced by emergency physicians. With the advent of video laryngoscopy, the rates of first-pass success continue to increase, and the effect of the anatomically difficult airway has begun to lessen. With advances in tools for airway management, the challenges have shifted to approaching optimal preoxygenation and correction of physiologic disturbances prior to any intubation attempt. This review discusses traditional rapid sequence intubation and advances in the field of emergency airway management.  This review contains 6 figures, 6 tables and 74 references Key words: difficult airway, emergency airway management, preoxygenation, surgical airway

scholarly journals Emergency airway management in a Singapore centre: A registry study

2021 ◽  
Vol 50 (1) ◽  
pp. 42-51
Author(s):  
Gene Wai Han Chan ◽  
Chew Yian Chai ◽  
Joy Su-Yue Teo ◽  
Calvin Kai En Tjio ◽  
Mui Teng Chua ◽  
...  
Keyword(s):  
Adverse Events ◽  
Airway Management ◽  
Difficult Airway ◽  
Rapid Sequence Induction ◽  
University Hospital ◽  
Rapid Sequence Intubation ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Medical Indications

ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians’ initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction

scholarly journals Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jutamas Saoraya ◽  
Komsanti Vongkulbhisal ◽  
Norawit Kijpaisalratana ◽  
Suthaporn Lumlertgul ◽  
Khrongwong Musikatavorn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Difficult Airway ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Blocking Agents ◽  
Glottic View ◽  
First Pass

Abstract Background It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department. Methods We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored. Results During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view. Conclusions In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.

Rapid sequence intubation for pediatric emergency airway management

2002 ◽  
Vol 18 (6) ◽  
pp. 417-423 ◽  
Author(s):  
MARK J. SAGARIN ◽  
VINCENT CHIANG ◽  
JOHN C. SAKLES ◽  
ERIK D. BARTON ◽  
RICHARD E. WOLFE ◽  
...  
Keyword(s):  
Airway Management ◽  
Pediatric Emergency ◽  
Rapid Sequence Intubation ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence

scholarly journals Airway Management in Accident and Emergency

2021 ◽  
Author(s):  
Kemal Tolga Saracoglu ◽  
Gul Cakmak ◽  
Ayten Saracoglu
Keyword(s):  
Airway Management ◽  
Rapid Sequence Intubation ◽  
Training Materials ◽  
Accident And Emergency ◽  
Rapid Sequence ◽  
Surgical Airway ◽  
Tracheobronchial Injury ◽  
Airway Devices ◽  
Stabilization Technique ◽  
Extraglottic Airway Devices

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls.

scholarly journals Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study

2021 ◽  
Author(s):  
Danny J. N. Wong ◽  
Kariem El-Boghdadly ◽  
Ruth Owen ◽  
Craig Johnstone ◽  
Mark D. Neuman ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Rapid Sequence Induction ◽  
Middle Income ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Sequence Induction

Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results Successful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported—an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non–rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P = 0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P = 0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P = 0.001). Conclusions The authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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