First Aid for Burns

A review of burn first aid treatments highlights the paucity of evidence on which to make firm recommendations. The authors recommend using cold running tap water (between 2 and 15 degrees C) and to avoid ice or alternative therapies. The optimum duration of first aid application and the delay after the injury for which first aid can still be effective are two areas of research which need further exploration.

A review of first aid treatments for burn injuries
Burns. 2009 Sep;35(6):768-75

Mallampati unhelpful in ED patients

A prospective study of 366 patients requiring intubation in the ED revealed by logistic regression analysis that the only component of the ‘LEMON’ classification* to be independently associated with difficult intubation was a thyroid-hyoid distance of less than 2 finger breadths. They conclude that Mallampati classification is not a useful tool in predicting difficult intubation in the ED and that the LEMON acrostic can be modified to “LEON.”

Determination of difficult intubation in the ED
Am J Emerg Med. 2009 Oct;27(8):905-10

*Further definition of LEMON and information on difficult airways  are available in these presentation slides by Rob Vissers FACEP

Cricoid pressure during mask ventilation

While cricoid pressure’s effectiveness at preventing passive regurgitation and aspiration during intubation is disputed, it may be effectively applied during bag-mask ventilation to prevent gastric insufflation of air in both adults and children.

The prevention of gastric inflation–a neglected benefit of cricoid pressure
Anaesth Intensive Care. 1988 May;16(2):139-43

The effect of cricoid pressure on preventing gastric insufflation in infants and children
Anesthesiology. 1993 Apr;78(4):652-6

Cricoid pressure – ?not so useless after all

An interesting MRI-based study of adult volunteers takes a further look at whether cricoid pressure effectively occludes the digestive tract. The authors assert that the part of the digestive tract at the level of the cricoid is the distal hypopharynx, that it is fixed in relation to the airway (making the previously demonstrated lateral oesophageal displacement irrelevant), and that the lumen may be obliterated during Sellick’s manouevre.

Accompanying pro and con editorials reaffirm the need for further clinical evidence on the effectiveness of the technique.

Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant

Anesth Analg. 2009 Nov;109(5):1546-5