Endotracheal Intubation of COVID-19 Patients: Recommendations Endotracheal Intubation of COVID-19 Patients: Recommendations
This brief report presents updated guidance related to self-protection when intubating suspected or confirmed patients with COVID-19.Anesthesia & Analgesia (Source: Medscape Today Headlines)
Source: Medscape Today Headlines - April 29, 2020 Category: Consumer Health News Tags: Infectious Diseases Journal Article Source Type: news

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.
In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - April 8, 2020 Category: Consumer Health News Source Type: news

What Causes Respiratory Failure?
Discussion The respiratory system is a complex system. The upper airways must remain patient. The lower airways must interface with the vascular system. The musculoskeletal system must provide mechanical function and the central nervous system must provide overall control. Respiratory failure occurs when the overall system cannot support the body’s necessarily ventilation, oxygenation or both. Children are at higher risk of respiratory failure. They have few intrinsic lung parenchyma problems, but have very small airways that increase the airflow resistance by themselves but then have to contend with problems such as...
Source: PediatricEducation.org - December 2, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

The Cutting Edge of Adult Cricothyrotomy: Are EMS Protocols Keeping Up?
An ALS unit is dispatched for an adult patient complaining of severe painful swallowing and difficulty breathing. Upon arrival the patient is acutely decompensating with increasing respiratory effort and diminished color. Supplemental oxygen isn’t providing adequate perfusion. Due to the patient’s rapidly deteriorating condition, the decision is made to intubate. As the laryngoscope is slid beyond the oral cavity, severe epiglottic swelling is visualized. After one intubation attempt the swelling worsens. At this point, endotracheal intubation is not feasible. With no options left, the paramedic resorts to reaching for...
Source: JEMS Patient Care - June 14, 2019 Category: Emergency Medicine Authors: Garrett Thompson, AEMT, BS, MPH Tags: Airway & Respiratory Exclusive Articles Source Type: news

Succinylcholine vs. Rocuronium: Battle of the RSI Paralytics
You arrive on scene in an apartment to find a 25-year-old female who’s unresponsive and apneic in the bathroom by her roommate, covered in vomitus and surrounded by empty medication containers and a bottle of tequila. The patient’s roommate notes that the patient has a history of depression and drug abuse, takes “some medication every night,” and that the patient had been crying all day after her boyfriend broke up with her. Naloxone was administered by police with no effect, and the patient fails to breathe adequately on her own despite airway repositioning and suctioning. You quickly decide this patient requires ...
Source: JEMS Patient Care - May 14, 2019 Category: Emergency Medicine Authors: Joslyn Joseph, DO, EMT Tags: Airway & Respiratory Exclusive Articles Patient Care Source Type: news

Settlement in Bellingham (WA) Fire Department Intubation Case
  The city of Bellingham (WA) is settling a claim for damages after fire department personnel practiced endotracheal intubation techniques on a deceased man last year, according to a report. The Bellingham Herald reports that the City Council authorized the mayor to settle the claims for $75,000. Last July, 11 fire department employees admitted to performing "tube checks" on the body of Bradley Ginn Sr. while he was on the floor of Station 1. His body was waiting to be picked up to be taken to a funeral home. Ginn's son, Bradley Ginn Jr., filed a claim for $200,000 in damages. Besides to ...
Source: JEMS Patient Care - February 1, 2019 Category: Emergency Medicine Authors: JEMS Staff Tags: Patient Care News Source Type: news

Settlement in Bellingham (WA) Fire Department Intubation Case
  The city of Bellingham (WA) is settling a claim for damages after fire department personnel practiced endotracheal intubation techniques on a deceased man last year, according to a report. The Bellingham Herald reports that the City Council authorized the mayor to settle the claims for $75,000. Last July, 11 fire department employees admitted to performing "tube checks" on the body of Bradley Ginn Sr. while he was on the floor of Station 1. His body was waiting to be picked up to be taken to a funeral home. Ginn's son, Bradley Ginn Jr., filed a claim for $200,000 in damages. Besides to ...
Source: JEMS: Journal of Emergency Medical Services News - February 1, 2019 Category: Emergency Medicine Authors: JEMS Staff Tags: Patient Care News Source Type: news

It ’s About Paramedic Intubation Skill Maintenance, Not ETI vs. SGA
In this study, for all-comers, that was an abysmal 6%. This is an important number because it tells us that overall, successful resuscitation from cardiac arrest is rare and that a number of our efforts may have some statistically significant differences but the absolute effect on the gold standard outcome is rather small. But that’s a story for another time. The focus here is on airway management in cardiac arrest, and the suggestion that the “verdict is out” on whether or not paramedics should be using an endotracheal tube or a supraglottic device. (Source: JEMS Patient Care)
Source: JEMS Patient Care - November 6, 2018 Category: Emergency Medicine Authors: Stephen P. Wood, MS, ACNP-BC Tags: Airway & Respiratory Exclusive Articles Source Type: news

It ’s About Paramedic Intubation Skill Maintenance, Not ETI vs. SGA
Conclusion The PART study’s aim was to demonstrate that SGA is superior to SETI. Whether this is true or not remains to be seen. That doesn’t mean this study doesn’t have value. It clearly demonstrated that an important, time-honored and gold standard skill in resuscitation isn’t being practiced effectively by paramedics. The solution should not be to abandon the procedure. The solution is that we need to fix the problem. We need to enhance education, provide more opportunity for skills maintenance and develop systems that ensure that paramedics are regularly practicing these advanced skills. It is time for the EMS...
Source: JEMS Special Topics - November 6, 2018 Category: Emergency Medicine Authors: Stephen P. Wood, MS, ACNP-BC Tags: Airway & Respiratory Exclusive Articles Source Type: news

Ambulance Crew Configuration: Are Two Paramedics Better Than One?
Conclusion Understanding ideal crew configuration is vital to maintain EMS systems. There’s a lack of evidence demonstrating the need for a second ALS provider on a general ALS response. Implications of overstaffing may result in more patient care errors and draining of financial resources which could be spent on additional state-of-the-art medical equipment or number of units resulting in better system performance and patient care. References 1. Robbins V: History of ambulance services and medical transpoortation systems in the United States. In JT Lindsey (Ed.), Management of ambulance services. Pearson: Boston, pp. 27...
Source: JEMS Special Topics - October 8, 2018 Category: Emergency Medicine Authors: Vincent D. Robbins, FACPE, FACHE Tags: Exclusive Articles Operations Source Type: news

Airway, Breathing or Consequences: Use Your Tools and Trust the Technology
Conclusion Ongoing confirmation of proper placement of an airway device is critical. Whether by a colorimetric device, capnometry, or, ideally, capnography, the tools should always be available and always be used. Note that there’s no mention of when this confirmation should take place. That’s because it’s essential to ensure that the tube is in the right spot and stays in the right spot. Each time, every time, all the time! As a healthcare provider, it’s essential to know your equipment, its uses and its limitations. You’re responsible for understanding not only how and why these tools work, but also how and why...
Source: JEMS Special Topics - October 1, 2018 Category: Emergency Medicine Authors: Scott DeBoer, RN, MSN, CEN, CPEN, CCRN, CFRN, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news

State Investigating Washington Firefighters Training on Dead Body
BELLINGHAM, Washington (KIRO) - The state health department is now investigating after firefighters in Bellingham did an intubation procedure on a dead patient for their own training. Washington Firefighters Misuse Funeral Home Body for Intubation Training An investigative report by the city found 11 employees attempted to intubate the body 15 times on the floor of a fire station. When a nursing home patient died in a Bellingham medic unit this summer, firefighters brought his body to a fire station when the hospital didn't accept it. According to a city investigation obtained by KIRO 7, when the funeral home reported it w...
Source: JEMS Administration and Leadership - September 27, 2018 Category: Emergency Medicine Tags: News Administration and Leadership Source Type: news

State Investigating Washington Firefighters Training on Dead Body
BELLINGHAM, Washington (KIRO) - The state health department is now investigating after firefighters in Bellingham did an intubation procedure on a dead patient for their own training. Washington Firefighters Misuse Funeral Home Body for Intubation Training An investigative report by the city found 11 employees attempted to intubate the body 15 times on the floor of a fire station. When a nursing home patient died in a Bellingham medic unit this summer, firefighters brought his body to a fire station when the hospital didn't accept it. According to a city investigation obtained by KIRO 7, when the funeral home reported it w...
Source: JEMS: Journal of Emergency Medical Services News - September 27, 2018 Category: Emergency Medicine Tags: News Administration and Leadership Source Type: news

ETI vs. SGA: The Verdict Is In
This study had several important limitations. The EMS agencies that participated in this trial have many years of experience in OHCA research, including additional training on CPR quality performance. As previously noted, due to limitations in funding, we couldn’t assess the influence of CPR quality. We studied a relatively limited number of out-of-hospital and in-hospital adverse events. It also wasn’t possible to blind EMS providers to treatment assignment. Although randomization was uneven in two sites, the overall characteristics of the study groups were similar. We observed a lower than expected ETI success rate; ...
Source: JEMS Special Topics - August 30, 2018 Category: Emergency Medicine Authors: Shannon W. Stephens, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news

ETI vs. SGA: The Verdict Is In
Engine 32 and Rescue 4 respond to a person not breathing at a youth sports complex. They arrive to see bystanders performing CPR and applying the facility’s automated external defibrillator (AED). While exiting the vehicle, paramedics hear the AED deliver a shock. Because of the large crowd gathered around the patient, paramedics and EMTs quickly load the patient into the back of the ambulance. En route, one medic starts an IV line while the other attempts intubation. The patient’s short neck and small mouth make the intubation effort very difficult. The medic attempts laryngoscopy three times, each time with a 45 seco...
Source: JEMS Patient Care - August 30, 2018 Category: Emergency Medicine Authors: Shannon W. Stephens, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news