Accéder au contenu principal
Par

Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital.

Sheeran PW, Walsh BK, Finley AM, Martin AK, Brenski AC.

Abstract

BACKGROUND:

Appropriate recognition and management of the pediatric difficult airway is essential. Two patient deaths in a 2-year period involving children with a known difficult airway led to the formation of the institution's multidisciplinary Difficult Airway Committee.

METHODS:

Patients with a suspected difficult airway or a known difficult airway are entered into a registry of difficult airway patients. A note describing the airway and any experiences at airway manipulation is entered as part of a difficult airway note in the patient's electronic medical record as soon as the patient is recognized as having a difficult airway. A call system has been developed to mobilize expert emergency airway assistance for these patients. Multiple additional methods are employed to ensure that all hospital personnel are aware that these patients are difficult to intubate.

RESULTS:

Since inception almost 6 years ago, 164 patients (mean age 9.2 years) have been enrolled in the difficult airway registry. Eighty-seven patients (53%) had one of 28 identified syndromes or diagnoses. The most common reasons for airway obstruction were mandibular hypoplasia/micrognathia, decreased neck extension, and limited temporomandibular joint mobility. One hundred sixty-one patients (98%) in the registry were predicted by history or physical to have a difficult airway. The mortality of registry patients was 9.8% (n = 16) and was most commonly due to co-existing diseases. During the time period reviewed, there was one in-hospital death of a known difficult airway patient, in which expert airway assistance was not obtained in a timely fashion.

CONCLUSION:

The institution's difficult airway registry identifies patients with a suspected or known difficult airway. The presence of a difficult airway in children can usually be predicted based on history and physical examination by anesthesiologists and otolaryngologists. Providers without advanced airway skills, however, may not appreciate that an airway is difficult to intubate until multiple attempts have failed. Both redundant notification methods and a call system optimize medical care of these fragile patients.
© 2014 John Wiley & Sons Ltd.

Commentaires

Enregistrer un commentaire

Posts les plus consultés de ce blog

Abdominal pain after a motor vehicle accident

Par
CASE A 22-year-old man was brought to the ED complaining of abdominal pain after a rollover motor vehicle accident. He was the front seat passenger and was wearing a seat belt. Although he was trapped in the vehicle and it caught on fire, he did not suffer any cutaneous burns. History  The patient's past medical history was significant for attention-deficit hyperactivity disorder. He admitted to using tobacco and alcohol socially, but denied illicit drug use. He denied any medication use or drug allergies. A review of systems was positive for complaints of abdominal pain and anxiety. Physical examination  The patient's vital signs were: BP, 112/51 mm Hg; heart rate, 110 beats/minute; respirations, 23; SpO 2 , 95% on room air; and temperature, 37.4° C (99.3° F). On ED arrival, he was awake, alert, and oriented but appeared anxious and agitated. His pupils were equal, round, and reactive to light. His head was normocephalic with a 2-cm laceration on the left ear. The pati...
Enregistrer un commentaire
Lire la suite

HTML5 Games On Android

Par
On my last hollidays, I made two HTML5 games, and published on android market. Nowadays javascript has powerful libraries for doing almost everything, and also there are several compilers from java or c code to javascript, converting opengl c code to html5 canvas, but definitely, javascript execution is slower than dalvik applications, and of course much slower than arm c libs. For improving the speed of sounds and images loader, I have used javascript asynchronous execution and scheduling priority has been controlled with setTimeout/setInterval which deprioritize or priorize a code block. This games are published on the android market here: Android Planets and here: Far Planet Related news Hacker Hardware Tools Pentest Tools Port Scanner Hacker Tools For Mac Tools Used For Hacking Hacker Techniques Tools And Incident Handling Easy Hack Tools Hacking Tools Kit Hacking Tools Usb Hacker Hardware Tools Hacker Tools Hardware Hack Tools For Windows Hacking Tools For G...
Enregistrer un commentaire
Lire la suite

"Abre Las Puertas A La Inclusión": La Campaña De Donativos De ASCM Para Hacer Su Sede Más Accesible

Par
La Asociación Sociocultural ASCM lanza la campaña de recaudación de fondos: "Abre las puertas a la inclusión", con el objetivo de dotar su sede de una puerta automática.                                                       Campaña "Abre las puertas a la inclusión": Vídeo promocional.  La Asociación Sociocultural ASCM lanza, hoy, una campaña de recaudación de fondos para mejorar la accesibilidad de su sede de Ferrol y adaptarse a las medidas de seguridad y prevención que exige la nueva normalidad. "Abre las puertas a la inclusión" es el slogan de esta campaña de donativos, que se extenderá hasta el 24 de julio, y que busca la colaboración de la ciudadanía para lograr reunir los 3.599 euros necesarios para dotar su local de una puerta automática. ASCM lleva, desde su fundación en 1987, reivindicando la necesidad de pensar en clave de accesibilidad un...
Enregistrer un commentaire
Lire la suite