October 24, 2018

Background: Establishing IV access has become the norm for patients presenting to the ED.  However with increasing patient volumes, difficulty and delays in acquiring IV access, it seems that anything that could expedite care, reduce pain and suffering, and improve patient care would be welcomed in the ED.  There are several tricks I have learned along the way to achieve just this: No IV access, no problem…performing procedures like a boss…

June 25, 2018

Background: Emergency intubation in the ED is a potentially life-saving procedure in critically ill patients, but does have risks associated with it as we have discussed before on this blog. The authors of the study we are going to review today described a first-attempt intubation success (FPS) rate in the ED to be 85%, despite new technologies such as video laryngoscopy [2]. Successful endotracheal intubation on the initial attempt is vital as it reduces the likelihood of adverse events. Use of the bougie as the primary intubation approach may increase FPS but it is typically reserved as a rescue device only after failed intubation attempts. This is the first randomized controlled trial comparing the bougie vs endotracheal tube + stylet (ETT + stylet) in ED patients with at least 1 characteristic predictive of difficult intubation.  The trial is titled the Bougie use in Emergency Airway Management (BEAM) trial.

June 11, 2018

In terms of airway management, cricothyrotomy is one of the most advanced airway procedures an ED physician will perform.  It is a last resort procedure when a patient is not able to be ventilated/oxygenated and/or intubated.  Typically, this procedure requires the identification of certain landmarks such as the cricothyroid membrane, but what if you can’t identify any landmarks?  What do you do?  We got Rob Bryant on the show to discuss some aspects of a recent nightmare airway case he had. 

April 19, 2018

Background: Successful first-pass endotracheal intubation is the desired outcome of all ER physicians as this can stave off hypoxemia and aspiration.  The bougie is one tool we have in our armamentarium that may be able to help with intubation. Many providers use this device as a rescue device after a failed attempt at intubation, instead of as a primary device in intubation.  This study sought to investigate the use of the bougie as a primary intubation device (Bougie 1st Intubation) in the ED instead of as a backup or adjunct in the ED.

April 12, 2018

Background:Endotracheal intubation is a common occurrence in the ED. Many patients requiring airway management are at a higher risk of hypoxia due to deranged respiratory physiology (i.e. decreased functional residual capacity and/or increased shunt fraction).  Advocates of video laryngoscopy argue that it provides better visualization of the airway anatomy, but it is less clear if better visualization correlates with better patient oriented outcomes. Good preparation, pre-oxygenation, and having a plan A, B, and C prior to intubation are essential requirements in 1st pass intubation success rate and decreased intubation time.  What is less clear is should plan A be VL or DL?
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