Chest Radiograph Interpretation: Online Teaching Resources for Non-Radiologists.

Chest radiographs provide vital information to clinicians. Medical professionals need to be proficient in interpreting chest radiographs to care for patients. This review examines online methods for teaching chest radiograph interpretation to non-radiologists.

Retire the Conventional Laryngoscope?

Video laryngoscopy is useful when direct laryngoscopy fails. However, should video laryngoscopy replace conventional laryngoscopy? We sought evidence updating previous systematic reviews examining whether video laryngoscopy should replace direct laryngoscopy for routine adult intubations performed by experienced anesthesia providers in the operating room. Six randomized controlled trials met the inclusion criteria.

Using Anesthesia Machines as Critical Care Ventilators During the COVID-19 Pandemic.

Somewhere between 30% and 89% of patients with COVID-19 admitted to a critical care unit require invasive mechanical ventilation. Concern over the lack of adequate numbers of critical care ventilators to meet this demand led the U.S.

Ketamine and Treatment-Resistant Depression.

Major depressive disorder affects tens of millions of people each year. One-third of those affected have depression that is resistant to conventional pharmacologic, psychologic, or somatic treatments. Patients with treatment-resistant depression have few remedies other than electroconvulsive therapy or transcranial magnetic stimulation.

Anesthetic Management of a Patient With Type 1 von Willebrand Disease and Uterine Placental Abruption: A Case Report.

Von Willebrand disease is the most common inherited blood disorder, occurring in about 1% of the population. It results from a deficiency in the quality or quantity of von Willebrand factor, which is necessary for adequate hemostasis. An evidenced-based approach is prudent when this derangement is coupled with a potentially fatal obstetric complication.

Pharmacologic Methods for Preventing Pruritus in Patients Receiving Intrathecal Opioids for Cesarean Delivery.

Neuraxial anesthesia with the addition of opioids is the preferred technique for cesarean delivery because of the safety and efficacy of the technique compared with general anesthesia. However, pruritus associated with neuraxial opioids is reported by patients to be one of the most distressing side effects and is a source of patient dissatisfaction. The incidence of pruritus has been reported to be as high as 100%.

Safe Driving After Propofol Sedation.

Purpose: Propofol is a short-acting medication with fast cognitive and psychomotor recovery. However, patients are usually instructed not to drive a motor vehicle for 24 hours after receiving propofol. The purpose of this article was to review the evidence examining when it is safe to drive after receiving propofol for sedation for diagnostic and surgical procedures.

Forced-Air Warmers and Surgical Site Infections in Patients Undergoing Knee or Hip Arthroplasty.

The majority of the evidence indicates preventing inadvertent perioperative hypothermia reduces the incidence of many perioperative complications. Among the results of inadvertent perioperative hypothermia are increased bleeding, myocardial events, impaired wound healing, and diminished renal function. Most researchers agree there is an increased incidence of surgical site infections in patients who experience inadvertent perioperative hypothermia.

Pediatric Tonsillectomy and Ketorolac.

Background: The use of ketorolac in children undergoing tonsillectomy remains limited because of the concern about postoperative bleeding.

Methods: A search was performed addressing the question: For patients undergoing a surgical tonsillectomy, does a weight-appropriate single dose of intravenous ketorolac affect the incidence of postoperative hemorrhage?

Results: Five systematic reviews met the inclusion criteria. A Cochrane Review included 15 studies with 1,101 pediatric subjects and focused on perioperative bleeding requiring intervention.

Evidence-Based Selection of Sedation Agents for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.

Sedating patients undergoing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) is challenging for the endoscopy team. Considering these challenges and concerns with the use of propofol for deep sedation of older adults and high-risk patients, colleagues of one of the authors (AS) were interested in the identification of techniques for the anesthetic management of subjects undergoing therapeutic ERCP. A search strategy revealed a total of 7 evidence sources.

Methods to Improve Success With the GlideScope Video Laryngoscope.

Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports.

The Information Age and Hot Air.

Forced-air warmers have been used for over twenty years to help prevent and treat inadvertent perioperative hypothermia. One result of hypothermia can be an increased risk of surgical site infection. Paradoxically, the question has been raised about the role of forced-air warmers in causing surgical site infections.

Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation.

Postoperative sore throat (POST) is usually self-limiting but was rated by patients as one of the top 10 most undesirable anesthetic outcomes. Pharmacologic interventions that have been suggested to decrease the incidence of POST include application of local anesthetics and corticosteroids to the cuff of the endotracheal tube. These interventions often require extra steps during induction of general anesthesia.

An update: use of laryngeal mask airway devices in patients in the prone position.

Some providers advocate using laryngeal mask airways (LMAs) for procedures performed in the prone position to meet the demands of quicker operating room turnover time requirements, staffing reductions and the desire to expedite patient recovery in the postoperative period. We provide an update to a 2010 systemic review examining the use of LMAs in patients in the prone position. Six peer-reviewed articles described the use of LMAs in prone patients: a randomized controlled trial, 2 description studies, a case series, and 2 case reports.

An evidence-based review of the use of a combat gauze (QuikClot) for hemorrhage control.

Trauma is a leading cause of morbidity and mortality. Uncontrolled hemorrhage related to the traumatic event is often the major cause of complications and death. The use of hemostatic agents may be one of the easiest and most effective methods of treating hemorrhage.

An evidence-based review of epinephrine administered via the intraosseous route in animal models of cardiac arrest.

Objectives: Intraosseous (IO) access, enabling the rapid administration of epinephrine during cardiac arrest (CA), is crucial in promoting optimal postresuscitation outcomes in patients with poor vascular access. There is a question whether IO-administered epinephrine is equivalent to intravenously administered epinephrine during CA.

Methods: The question guiding this evidence-based review was as follows: in adults suffering CA given epinephrine via the IO route, what is the resulting serum concentration of the drug compared to when administered intravenously? A search was conducted and the evidence appraised and leveled.

A review of the evidence for active preoperative warming of adults undergoing general anesthesia.

Inadvertent perioperative hypothermia, a common occurrence in the operating suite, is associated with many adverse outcomes. It is the nurse anesthetist's goal to attenuate the incidence of this problem. Although active intraoperative warming is a widely accepted practice, active preoperative warming may be a less explored option for temperature maintenance.

Patients with aortic stenosis: who should undergo noncardiac surgery in a rural hospital?

Purpose: Sometimes, patients in rural settings with aortic stenosis not severe enough to require valve replacement desire to undergo elective noncardiac procedures at their small local hospital. This has important implications for all stakeholders, including perianesthesia nurses. The purpose of this evidence-based article was to determine when it is appropriate for patients with aortic stenosis to undergo noncardiac surgery in this setting.

Forced-air warming devices and the risk of surgical site infections.

The potential that forced-air warming systems may increase the risk of surgical site infections (SSIs) by acting as a vector or causing unwanted airflow disturbances is a concern to health care providers. To investigate this potential, we examined the literature to determine whether forced-air warming devices increase the risk of SSIs in patients undergoing general, vascular, or orthopedic surgical procedures. We examined 192 evidence sources, 15 of which met our inclusion criteria.

Predicting success in nurse anesthesia programs: an evidence-based review of admission criteria.

Nurse anesthesia programs strive to minimize attrition due to academic reasons and maximize student success. The authors examined the evidence for evaluating applicants to nurse anesthesia programs that may help predict success in the program and on the National Certification Examination for Nurse Anesthetists. A search strategy guided gathering of evidence from peer-reviewed journals.

Evidence for using air or fluid when identifying the epidural space.

Lumbar epidural analgesia is frequently employed to provide pain relief for women during labor. Anesthesia providers use various methods to identify the epidural space. Some providers use air, some use fluid, and others use a combination of air and fluid during the loss of resistance technique.