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The difficult airway in the emergency department

BACKGROUND: The patient with difficult airways is a common challenge for emergency physicians. AIMS: Our goal was to study the reasons for difficult airways in the emergency department. METHODS: We performed a prospective observational study of patients requiring advanced airway management from 1 Ja...

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Detalles Bibliográficos
Autores principales: Wong, Evelyn, Ng, Yih-Yng
Formato: Texto
Lenguaje:English
Publicado: Springer-Verlag 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657243/
https://www.ncbi.nlm.nih.gov/pubmed/19384660
http://dx.doi.org/10.1007/s12245-008-0030-6
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author Wong, Evelyn
Ng, Yih-Yng
author_facet Wong, Evelyn
Ng, Yih-Yng
author_sort Wong, Evelyn
collection PubMed
description BACKGROUND: The patient with difficult airways is a common challenge for emergency physicians. AIMS: Our goal was to study the reasons for difficult airways in the emergency department. METHODS: We performed a prospective observational study of patients requiring advanced airway management from 1 January 2000 to 31 December 2006. RESULTS: There were 2,343 patients who received advanced airway management of which 93 (4.0%) were deemed difficult. The main diagnoses were cardiac arrest (28), trauma (27) and congestive heart failure (10). The main reasons for the difficult airways were attributed to an anterior larynx (38, 40.9%), neck immobility (22, 23.7%) as well as the presence of secretions and blood (14, 15.1%). The mean number of attempts at intubation was 3.6 versus 1.2 for all cases. The mortality rate of 40.5% among patients with difficult airways was not different from that of all patients who had airway management (41%). There were seven (0.3%) failed airways. Anaesthetists performed 21 (22.6%) of the rescue airways while surgeons performed 5 (5.4%). Of the rescue strategies performed, 24 were through the use of the bougie, 3 by cricothyroidotomy, 4 by tracheostomy, 6 with the GlideScope and 3 with the laryngeal mask airway. The rest the airways were secured by tracheal intubation using the laryngoscope. CONCLUSIONS: Emergency physicians manage most of the difficult airways successfully (68.8%). However, the success rate can be further improved through the more frequent use of the bougie or other rescue device. A possible suggestion would be for the emergency physician to use the bougie after the second or third attempt at direct orotracheal intubation.
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spelling pubmed-26572432009-03-25 The difficult airway in the emergency department Wong, Evelyn Ng, Yih-Yng Int J Emerg Med Original Article BACKGROUND: The patient with difficult airways is a common challenge for emergency physicians. AIMS: Our goal was to study the reasons for difficult airways in the emergency department. METHODS: We performed a prospective observational study of patients requiring advanced airway management from 1 January 2000 to 31 December 2006. RESULTS: There were 2,343 patients who received advanced airway management of which 93 (4.0%) were deemed difficult. The main diagnoses were cardiac arrest (28), trauma (27) and congestive heart failure (10). The main reasons for the difficult airways were attributed to an anterior larynx (38, 40.9%), neck immobility (22, 23.7%) as well as the presence of secretions and blood (14, 15.1%). The mean number of attempts at intubation was 3.6 versus 1.2 for all cases. The mortality rate of 40.5% among patients with difficult airways was not different from that of all patients who had airway management (41%). There were seven (0.3%) failed airways. Anaesthetists performed 21 (22.6%) of the rescue airways while surgeons performed 5 (5.4%). Of the rescue strategies performed, 24 were through the use of the bougie, 3 by cricothyroidotomy, 4 by tracheostomy, 6 with the GlideScope and 3 with the laryngeal mask airway. The rest the airways were secured by tracheal intubation using the laryngoscope. CONCLUSIONS: Emergency physicians manage most of the difficult airways successfully (68.8%). However, the success rate can be further improved through the more frequent use of the bougie or other rescue device. A possible suggestion would be for the emergency physician to use the bougie after the second or third attempt at direct orotracheal intubation. Springer-Verlag 2008-05-29 /pmc/articles/PMC2657243/ /pubmed/19384660 http://dx.doi.org/10.1007/s12245-008-0030-6 Text en © Springer-Verlag London Ltd 2008
spellingShingle Original Article
Wong, Evelyn
Ng, Yih-Yng
The difficult airway in the emergency department
title The difficult airway in the emergency department
title_full The difficult airway in the emergency department
title_fullStr The difficult airway in the emergency department
title_full_unstemmed The difficult airway in the emergency department
title_short The difficult airway in the emergency department
title_sort difficult airway in the emergency department
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657243/
https://www.ncbi.nlm.nih.gov/pubmed/19384660
http://dx.doi.org/10.1007/s12245-008-0030-6
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