Paradoxical Agitation and Masseter Spasm During Propofol Procedural Sedation: A Case Report.

Introduction: Propofol is an anesthetic agent commonly used in emergency department (ED) procedural sedation. It is often preferred in orthopedic procedures because of its muscle-relaxing properties. Rarely, however, it can induce agitation and muscle hypertonicity.

Shelters in Alpine Rescue: Can They Create a Comfortable Zone at the Deployment Site?

Introduction: Lightweight shelters made of water- and windproof polyester are frequently used by mountain rescue, but information on physical and psychological stress during their use is scarce.

Methods: A prospective observational study was conducted with 48 experienced rescuers who performed cardiopulmonary resuscitation training on a manikin in a shelter in alpine terrain. The objective parameters of air temperature, moisture, and concentrations of carbon dioxide and oxygen were measured inside the shelter.

Airway Management in Tactical Combat Casualty Care: TCCC Change 24-1.

Tactical Combat Casualty Care (TCCC) has been designated by the U.S. Department of Defense as the military standard for battlefield trauma care.

Successful management of immunotherapy-resistant respiratory failure in anti-mitochondrial M2 antibody-positive myositis by modified lung volume recruitment therapy: A case report.

Rationale: Anti-mitochondrial antibodies (AMA) M2-positive myositis can lead to severe respiratory failure. Traditional immunotherapies sometimes fail to address respiratory failure. Herein, this CARE-compliant case report described a patient with AMA-M2-positive myositis who recovered from ventilation with tracheostomy owing to immunotherapy-resistant respiratory failure to spontaneous breathing after modified lung volume recruitment (mLVR) therapy.

Consensus Guideline for Care of Patients in the Prehospital and Aerospace Settings with Exposures to Hydrazine and Hydrazine Derivatives.

Objectives: Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time.

Prehospital ventilation strategies in out-of-hospital cardiac arrest: A protocol for a randomized controlled trial (PIVOT trial).

Aims: The PIVOT trial evaluates the clinical outcomes and ventilatory quality of an automatic pneumatic ventilation method compared to a bag-valve-mask ventilation method in patients who have experienced out-of-hospital cardiac arrest and have had an advanced airway placed.

Methods: The PIVOT trial is a pragmatic, open-label, multicenter randomized controlled trial. It aims to recruit 514 patients in Hsinchu County, Taiwan.

A Comparison of Using Cuffed and Uncuffed Face Masks for Providing Manual Bag Ventilation in Elderly Patients with Obesity.

Background: With the improvement of healthcare, the number of elderly individuals, including those with obesity, is increasing. The accumulation of various ventilation problems associated with the use of face masks in both these patient groups can pose a challenge even for an experienced anesthesiologist. The main aim of this study was to evaluate the ventilation of elderly patients with obesity using face masks, uncuffed or cuffed, and compare it with values obtained among patients with obesity who are not elderly.

Tube Tip in Pharynx (TTIP) Ventilation-a Simple Rescue Technique in Limited Resource Settings.

Airway devices may be scarce in limited resource situations, such as prehospital settings or austere environments. Tube tip in pharynx (TTIP) ventilation is a simple, one-handed technique that may prove valuable for ensuring airway control in a life-threatening situation. The technique only requires a standard cuffed endotracheal tube and a self-inflating bag.

Pathophysiology and Prevention of Manual-Ventilation-Induced Lung Injury (MVILI).

Manual ventilation, most commonly with a bag-valve mask, is a form of short-term ventilation used during resuscitative efforts in emergent and out-of-hospital scenarios. However, compared to mechanical ventilation, manual ventilation is an operator-dependent skill that is less well controlled and is highly subject to providing inappropriate ventilation to the patient. This article first reviews recent manual ventilation guidelines set forth by the American Heart Association and European Resuscitation Council for providing appropriate manual ventilation parameters (e.

Life-threatening nasotracheal tube obstruction by a blood clot: a case report.

The nasotracheal tube (NTT) is frequently used in oral and maxillofacial surgery and is generally considered a safe means of protecting the airway while ensuring an adequate surgical field. The most common complication associated with NTT is epistaxis, and only a few cases of foreign body obstruction have been reported. In this case report, the authors aimed to highlight the potential for NTT obstruction following surgery.

Maintenance of CPR skills among nursing students trained using Resuscitation Quality Improvement® program.

Background: The Resuscitation Quality Improvement® (RQI) program is a competency-based approach that provides low dose, high frequency cardiopulmonary resuscitation (CPR) skills training. Limited research has evaluated its effectiveness with nursing students who need to be prepared to respond to cardiopulmonary emergencies despite their student status and to be competent in CPR as they transition into practice.

Objective: The objective of this multisite longitudinal study was to examine the maintenance of adult and infant compressions and ventilation skills by nursing students at 3 and 6 months following practice with real-time feedback using the RQI® program.

Improving pediatric procedural skills and EPA assessments through an acute care procedural skills curriculum.

Introduction: Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine.

Materials And Methods: Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt.

A Case Report of Delayed Opioid Toxidrome After Administration of Naloxone.

Introduction: Opioid use is an epidemic that plagues the United States. Patients frequently present to the emergency department (ED) after opioid toxicity, which can lead to respiratory failure, apnea, and death. Although there is an effective antidote, naloxone, the current guidelines surrounding post-naloxone administration monitoring are loosely defined.

Evaluation of the retention of knowledge, skills and competency of post-neonatal resuscitation training among house officers.

Introduction: The Neonatal Resuscitation Programme (NRP) was first introduced in Malaysia in 1996 to train doctors and nurses working in paediatrics and obstetrics departments who are involved with the care of newborns soon after delivery. Prompt and effective neonatal resuscitation has been documented to reduce mortality and neonatal asphyxia. The programme has been revised every five years and is now in the 8th edition.

Gastric Inflation in Prehospital Cardiopulmonary Resuscitation: Aspiration Pneumonia and Resuscitation Outcomes.

Background: Gastric inflation (GI) can induce gastric regurgitation and subsequent aspiration pneumonia, which can prolong intensive care unit stay. However, it has not been verified in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the incidence of GI during prehospital resuscitation and its effect on aspiration pneumonia and resuscitation outcomes in patients with out-of-hospital cardiac arrest.

Preemptive airway management planning: A retrospective evaluation of the pediatric difficult airway consultation service.

Background/aims: The pediatric Difficult Airway Consultation Service (pDACS) was created in 2017 to identify patients with potentially difficult airways and create airway management plans prior to airway management.

Methods: Consults were either nurse-initiated, physician-initiated, or both nurse-and-physician-initiated and were examined for demographic and clinical factors. If a child had difficult airway risk factors, a consult note with airway management recommendations was completed.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial.

Objectives: An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use.