scholarly journals A Survey of Residency Directors in Academic Trauma Centers for Policies on Airway Management in The Trauma Ward

2021 ◽  
Author(s):  
George Tewfik ◽  
Michal Gajewski ◽  
Jena Salem ◽  
Neil Borad ◽  
Michael Zales ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Improve Patient Care ◽  
The United States ◽  
Trauma Centers ◽  
Difficult Airways ◽  
Level I ◽  
Trauma Activation ◽  
Trauma Bay

Abstract Background Despite its presence as a critical procedure in the trauma setting, airway management is not performed uniformly, varying between institutions, particularly with personnel involved in decision-making. Past literature has noted a trend in which emergency medicine physicians assumed greater responsibility for primary management of airways in the trauma ward. In addition, many institutions have adopted tiered activation systems for traumas in order to improve patient care, deploying resources more effectively. In this study, a survey of residency directors was deployed to assess trends in airway management. Methods A validated survey was distributed to residency directors in anesthesiology, general surgery and emergency medicine in 190 Level I trauma centers in the United States. Questions assessed personnel management, complication tracking and difficult airway prediction factors, amongst other considerations for airway management in the trauma bay. Results Respondents completed the survey at a rate of 23.8% of those solicited. A majority of respondents indicated that emergency medicine physicians are primary airway managers in the trauma bay and that their institutions utilize tiered trauma activation systems at 77.4% and 95.6% respectively. Anesthesia providers were immediately available in 81% of respondent institutions with inconclusive data regarding protocols for delineating anesthesia involvement in difficult airways. More than a third of respondents indicated their institution either does not track airway complications or they did not know if complications were tracked. Finally, nine different criteria were used in varying degrees by respondents’ institutions to predict the presence of a difficult airway, including such factors as head/face trauma, airway fluid and obesity. Conclusion The trend towards airway management by emergency medicine physicians in the trauma bay continues, with anesthesia personnel available in many situations to assist in complicated patients. Complication tracking for airway management remains inconsistent, as does the criteria for prediction of the presence of difficult airways.

scholarly journals Are trauma research programs in academic and non-academic centers measured by equal standards? A survey of 137 level I trauma centers in the United States

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Robert M. Madayag ◽  
Erica Sercy ◽  
Gina M. Berg ◽  
Kaysie L. Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
General Surgery ◽  
Trauma Surgery ◽  
The United States ◽  
Full Time ◽  
Trauma Centers ◽  
Patient Volume ◽  
Non Profit ◽  
Trauma Research ◽  
Research Programs ◽  
Level I

Abstract Background American College of Surgeons level I trauma center verification requires an active research program. This study investigated differences in the research programs of academic and non-academic trauma centers. Methods A 28-question survey was administered to ACS-verified level I trauma centers in 11/12/2020–1/7/2021. The survey included questions on center characteristics (patient volume, staff size), peer-reviewed publications, staff and resources dedicated to research, and funding sources. Results The survey had a 31% response rate: 137 invitations were successfully delivered via email, and 42 centers completed at least part of the survey. Responding level I trauma centers included 36 (86%) self-identified academic and 6 (14%) self-identified non-academic centers. Academic and non-academic centers reported similar annual trauma patient volume (2190 vs. 2450), number of beds (545 vs. 440), and years of ACS verification (20 vs. 14), respectively. Academic centers had more full-time trauma surgeons (median 8 vs 6 for non-academic centers) and general surgery residents (median 30 vs 7) than non-academic centers. Non-academic centers more frequently ranked trauma surgery (100% vs. 36% academic), basic science (50% vs. 6% academic), neurosurgery (50% vs. 14% academic), and nursing (33% vs. 0% academic) in the top three types of studies conducted. Academic centers were more likely to report non-profit status (86% academic, 50% non-academic) and utilized research funding from external governmental or non-profit grants more often (76% vs 17%). Conclusions Survey results suggest that academic centers may have more physician, resident, and financial resources available to dedicate to trauma research, which may make fulfillment of ACS level I research requirements easier. Structural and institutional changes at non-academic centers, such as expansion of general surgery resident programs and increased pursuit of external grant funding, may help ensure that academic and non-academic sites are equally equipped to fulfill ACS research criteria.

scholarly journals Making the transition in difficult airway management: are new perspectives in critical emergency medicine nurses curricula needed?

Resuscitation ◽  
2019 ◽  
Vol 142 ◽  
pp. e64
Author(s):  
Ileana Lulic ◽  
Saqr AlHemeiri ◽  
AlAnood Bin Sulaiman ◽  
Afaf Sayed Jaafer ◽  
Mirna Diab ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management

Management of the Difficult Airway

2018 ◽  
pp. 8-12
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Brain Damage ◽  
Retrospective Review ◽  
Historical Study ◽  
Difficult Airway Management ◽  
Management Planning ◽  
Review Analysis ◽  
Malpractice Claims ◽  
Difficult Airways

This chapter focuses on a study reviewing management of difficult airways to address the question: What are the patterns of liability associated with malpractice claims arising from cases involving difficult airway management? This was a historical study of cases of difficult airway claims occurring between 1985 and 1999, which were reviewed in conjunction with the success of the Difficult Airway Guidelines published in 1993. Although this is a retrospective review, analysis of difficult airway claims demonstrated a reduction in death or brain damage with induction of anesthesia in 1993–1999 compared with 1985–1992, suggesting that the Difficult Airway Guidelines published in 1993 improved airway management planning in cases with anticipated difficult airways.

scholarly journals LEMON SCORE: A TOOL TO PREDICT DIFFICULT AIRWAY IN ED IN INDIAN SETTING.

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Sumalya Tripathi ◽  
Dr V.S Shinde ◽  
Zahid Parvez Shaikh
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Invasive Mechanical Ventilation ◽  
Common Finding ◽  
Successful Resuscitation ◽  
Emergency Airway ◽  
Indian Setting ◽  
Lemon Score ◽  
Neck Mobility

Background: Airway management is a critical need in many acutely ill and injured patients. Inadequate delivery of oxygen to brain and other vital structures is the quickest killer. Emergency airway management is the major key for successful resuscitation in ED. Emergency medicine is an emerging branch in India at present and no research study has been conducted to evaluate difficult airway prediction score. Hence this study aimed to find the use of LEMON score as a tool to predict difficult airway in our ED. Methods: All the patients requiring invasive mechanical ventilation with age >12 years, not admitted outside and admitted to the emergency medicine department from July 2017 to September 2019 were included in our study.  A total of 67 patients required invasive ventilation and were assessed by LEMON score for difficult intubation. This score is related to number of attempts required and Cormack lehane class of laryngoscopic view while intubation. Results: In the “LOOK EXTERNALLY” the most common finding was edentulous mouth with occurrence of 26.87%. In ‘EVALUATE’ component the most common difficulty was 2-3-2. In MALLAMPATI CLASS 56.71% were class I, 39.39% were class II. In OBSTRUCTION component of LEMON, 98.51% had no obstruction. In NECK MOBILITY component we found that 85.1% subjects had mobile neck and only 15.15% subjects had restricted neck mobility. We observed that the LEMON score is 60% sensitive and 96.15% specific to predict difficult airway. The positive predictive value was 83.33%. Conclusion: This tool can reduce the chance of unexpectedly encountering difficult airway.

scholarly journals Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Jérôme Sudrial ◽  
Caroline Birlouez ◽  
Anne-Laurette Guillerm ◽  
Jean-Luc Sebbah ◽  
Roland Amathieu ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Macintosh Laryngoscope ◽  
Difficult Airway Management ◽  
Arterial Oxygenation ◽  
Management Algorithm ◽  
Early Activation ◽  
Airway Devices

We report a case of prehospital “cannot intubate” and “cannot ventilate” scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.

Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

2013 ◽  
Vol 3 (1) ◽  
pp. 88-92
Author(s):  
Daniel S Mangiapani ◽  
Bret C Peterson ◽  
Ryan Kellogg ◽  
Fraser J Leversedge
Keyword(s):  
Real Time ◽  
Improve Patient Care ◽  
Hand Surgery ◽  
Emergency Call ◽  
Trauma Centers ◽  
Level Ii ◽  
The Us ◽  
Level 1 ◽  
Level I ◽  
Microvascular Replantation

ABSTRACT Purpose The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US. Materials and methods Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital. Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage. Level 2 centers 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol. Conclusion Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US: • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage; • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol; • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently; • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care. Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.

scholarly journals Potential synergy between advanced primary stroke centers and level I or II trauma centers in the United States

2012 ◽  
Vol 30 (8) ◽  
pp. 1535-1539
Author(s):  
Asif A. Khan ◽  
Saqib A. Chaudhry ◽  
Ameer E. Hassan ◽  
Gustavo J. Rodriguez ◽  
M. Fareed K. Suri ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Centers ◽  
Potential Synergy ◽  
Level I
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