Abstract:
STUDY OBJECTIVE:Preoxygenation is important to prevent oxygen desaturation during emergency airway management. The purpose of this study is to describe the use of end tidal oxygen (eto2) during rapid sequence intubation in the emergency department. METHODS:This study was carried out in 2 academic centers in Sydney, Australia, and New York City. We included patients undergoing rapid sequence intubation in the emergency department. A standard gas analyzer was used to measure eto2. Preoxygenation methods included nonrebreather mask and bag-valve-mask ventilation. We measured eto2 before preoxygenation and at administration of rapid sequence intubation medications. We also characterized peri-intubation SpO2, identifying instances of SpO2 less than 90%. RESULTS:We included 100 patients during a 6-month period. Median eto2 level before and after preoxygenation was 53% (interquartile range [IQR] 43% to 65%) and 78% (IQR 64% to 86%), respectively. One fourth of patients achieved an eto2 level greater than 85%. Median eto2 level achieved varied with preoxygenation method, ranging from 80% (IQR 60% to 87%) for the nonrebreather mask group to 77% (IQR 65% to 86%) for the bag-valve-mask group. The method with the highest median eto2 level was nonrebreather mask at flush rate (86%; IQR 80% to 90%) and the lowest median eto2 level was nonrebreather mask at 15 L/min (57%; IQR 53% to 60%). Eighteen patients (18%) experienced oxygen desaturation (SpO2 <90%); of these, 14 (78%) did not reach an eto2 level greater than 85% at induction. CONCLUSION:ETO2 varied with different preoxygenation techniques employed in the emergency department. Most patients undergoing rapid sequence intubation did not achieve maximal preoxygenation. Measuring ETO2 in the emergency department may be a valuable adjunct for optimizing preoxygenation during emergency airway management.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Caputo ND,Oliver M,West JR,Hackett R,Sakles JCdoi
10.1016/j.annemergmed.2019.01.038subject
Has Abstractpub_date
2019-09-01 00:00:00pages
410-415issue
3eissn
0196-0644issn
1097-6760pii
S0196-0644(19)30065-4journal_volume
74pub_type
杂志文章,多中心研究abstract::A 27-year-old man was admitted to the emergency department with a fluphenazine decanoate-induced dystonia. He was treated with 125 mg diphenhydramine IV in four doses and 2 mg benztropine IM. A fluctuating response was observed before continued remission of the dystonia. Possible reasons for variable patient responses...
journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
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doi:10.1016/S0196-0644(98)70358-0
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journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,评审
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journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:1990-03-01 00:00:00
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journal_title:Annals of emergency medicine
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更新日期:2015-09-01 00:00:00
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更新日期:1996-05-01 00:00:00
abstract::Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly app...
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pub_type: 杂志文章,评审
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journal_title:Annals of emergency medicine
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journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,随机对照试验
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doi:10.1016/s0196-0644(05)80890-x
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journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
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journal_title:Annals of emergency medicine
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doi:10.1067/mem.2002.116595
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journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80686-8
更新日期:1987-05-01 00:00:00
abstract:STUDY OBJECTIVE:The objectives of this systematic review and meta-analysis are to appraise the evidence in regard to the diagnostic accuracy of a low-risk History, ECG, Age, Risk Factors, and Troponin (HEART) score for prediction of major adverse cardiac events in emergency department (ED) patients. These included 4 su...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,meta分析
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abstract::A technique of direct mechanical ventricular assistance (DMVA) has been available since 1966. Ventricular assistance is provided by a glass cup lined with a Silastic diaphragm. It is held on the cardiac ventricles by suction. Alternating positive and negative pressure in the space between the cup and the diaphragm pro...
journal_title:Annals of emergency medicine
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abstract::The Hyatt Regency skywalk collapse (July 17, 1981) provided the emergency medical services system of Kansas City, Missouri, with its greatest challenge ever. Utilizing an EMS-based, centralized, city-wide disaster plan, the rescue operation encountered 113 dead and 188 multiply traumatized patients. The rescue operati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80203-0
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