In a randomised study of more than 1072 patients for emergency intubation using rapid sequence induction, single-use metal blades were associated with fewer failed first attempts and fewer poor grade laryngeal views than reusable metal blades. Improved illumination may be a factor. Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia Anesthesiology. 2010 Feb;112(2):325-32
A novel jaw thrust device (JTD) was tested against oropharyngeal and nasopharyngeal airways in anaesthetised patients. The JTD enabled effective ventilation with less airway resistance than the traditional airways, and so provided greater tidal volumes during pressure controlled ventilation. It fits into the mouth, keeping the mouth open and the jaw thrusted forward, and has a standard sized connector for attachment to ventilation devices. Optimising the unprotected airway with a prototype Jaw-Thrust-Device – a prospective randomised cross-over study Anaesthesia. 2009 Nov;64(11):1236-40
A very comprehensive (hence the title of the paper) review of medications required for pre-hospital & retrieval medicine missions was undertaken, resulting in recommendations. While the casemix seen by various services may be influenced by local geography or tasking restrictions, the list provides an excellent standard from which locally appropriate modifications can be made. Defining a standard medication kit for prehospital and retrieval physicians: a comprehensive review. Emerg Med J. 2010 Jan;27(1):62-71
After intubation it is critical to securely fasten the tracheal tube so it does not dislodge during transfer. Dedicated devices are available for this although mostly cloth tape is used.
Different knots have been compared although not found be significantly different in terms of security1. One favoured knot, which is easy to learn and to teach, is the lark’s head (also called cow’s hitch)2.
The tape is folded in half so there is a loop at one end and two free ends at the other. The loop is wrapped around the tube and the two free ends are fed through the loop, and then taped around the patient’s head. It has been suggested that this results in the tape gripping the tube over the widest possible area, thereby reducing the potential for slippage and displacement.
An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO
Emergency physicians at Singapore General Hospital found flow rates to be similar when comparing the tibia with the humerus as sites for adult IO access. The EZ-IO had a very high insertion success rate. It took about 12 minutes to infuse a litre of saline, which drops to about 6 minutes if a pressure bag is used.
Am J Emerg Med. 2009 Jan;27(1):8-15 http://www.ncbi.nlm.nih.gov/pubmed/19041528
Prehospital airway management on rescue helicopters in the United Kingdom
26 of 27 identified UK rescue helicopter bases responded to a questionnaire sent by German anaesthesiologists on the airway equipment they carried. The take home message is that there were some important gaps: not all carried equipment for establishing a surgical airway and not all had a means of capnometry. Pull your socks up guys the Germans are watching.
Anaesthesia. 2009 Jun;64(6):625-31 http://www.ncbi.nlm.nih.gov/pubmed/19453316
Trauma scissors vs the Rescue Hook, exposing a simulated patient: a pilot study
American military investigators compared traditional trauma scissors with the ‘rescue hook’ (a hooked knife with the cutting edge on the inside of the hook) in rapidly removing the clothes from a simulated casualty. An army desert combat uniform and boots were removed more quickly with the rescue hook, which was favoured by the combat medics employed in the study. We don’t have data on how it would work on denim, leather, or belts, but it looks pretty good. I just want to know if it’ll go through a sternum before I trade in my trauma scissors.
J Emerg Med. 2009 Apr;36(3):232-5 http://www.ncbi.nlm.nih.gov/pubmed/18155382
Paramedics intubated simulated patients positioned supine on the floor by direct laryngoscopy (DL) and by using the Airtraq device. Ventilation was achieved more quickly with the Airtraq in a difficult airway scenario (tongue oedema), and after a short training period the Airtraq was faster at intubating a ‘normal’ airway. Comparison of use of the Airtraq with direct laryngoscopy by paramedics in the simulated airway. Prehosp Emerg Care. 2009 Jan-Mar;13(1):75-80