A Performance Improvement Surveillance Project of Emergency Department Airway Management

From the American Journal of Medical Quality:

The aim of this study was to determine if use of a standardized airway data collection sheet can survey airway management practices in an emergency department. Success rates and trends from the authors’ facility have been benchmarked against the National Emergency Airway Registry (NEAR). This study included all patients requiring invasive airway management during a 21-month period (July 1, 2005, through March 31, 2007). An audit form was developed and implemented to collect data on intubations. During the study period, 224 patients required invasive airway control. Of all airways managed by emergency medicine residents, the intubation success rate was 99% (200/203; 95% confidence interval [CI] = 96%-100%), with 3% of those (6/203;95% CI = 1%-6%) requiring more than 3 attempts;3 patients (1%;95% CI = 0%-4%) could not be intubated and required a surgical airway. Use of an airway registry based on the NEAR registry as a benchmark of rates and types of successful intubation allows comparison of airway practices.

Strike tests Twin Cities nurses, patients

From the Star Tribune:

On Thursday morning, the two Florida nurses will report for work at the emergency room, just as they’ve been doing for years.

Except this time they’ll be doing it far from home and for a lot more money.

They are among the 2,800 replacements recruited from around the country to substitute for 12,000 Minnesota nurses who are expected to walk off the job Thursday morning at 14 Twin City hospitals.

SHELTER for Emergency Stroke Therapy

From Medgadget:

Insera Therapeutics of Sacramento, California has developed a new device for clearing brain thrombus during a stroke. Named SHELTER (Stroke Help using an Endo-Luminal Transcatheter Embolus Retrieval), the device features a 5mm wide nickel-titanium mesh that grabs the distal end of the thrombus, and an outer sheath to contain it. There’s also a soft tip on the front to prevent accidental rupturing of the vessel.

Do Resuscitation-Related Injuries Kill Infants and Children?

Ed. Answer: NO.

From the American Journal of Forensic Medicine and Pathology:

Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the “CPR defense,” that is, they attribute the cause of injuries found at autopsy to their “untrained” resuscitative efforts. A 10-year (1994–2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (Natraumatic = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in location. In our population, CPR did not result in any rib fractures or significant visceral injuries. Participation of nonmedical or untrained individuals in resuscitation did not increase the likelihood of injury.