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Prehospital endotracheal intubation: elemental or detrimental?

Pepe PE, Roppolo LP, Fowler RL - Crit Care (2015)

Bottom Line: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care.Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015.Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, USA. Paul.Pepe@UTSW.edu.

ABSTRACT
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Show MeSH
Endotracheal intubation in the out-of-hospital setting. In the early years of out-of-hospital emergency medical services (EMS) systems, advanced life support personnel were not only trained in the nuances of how to avoid overzealous ventilation and properly place an endotracheal tube in very challenging circumstances, but they were also well-supervised on-scene by expert physicians who themselves were highly-experienced and exceptionally familiar with those challenges as well as methods to overcome them (photo by Dr. Paul Pepe).
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Fig1: Endotracheal intubation in the out-of-hospital setting. In the early years of out-of-hospital emergency medical services (EMS) systems, advanced life support personnel were not only trained in the nuances of how to avoid overzealous ventilation and properly place an endotracheal tube in very challenging circumstances, but they were also well-supervised on-scene by expert physicians who themselves were highly-experienced and exceptionally familiar with those challenges as well as methods to overcome them (photo by Dr. Paul Pepe).

Mentions: Unlike the controlled in-hospital environment, in a sunny, bright outdoors setting, the ambient light causes glare and pupillary constriction for the rescuers. This circumstance requires that the practitioners are taught and understand the ‘tricks of the trade’, such as placing a coat or blanket over one’s head (and the head of the patient) in order to create a makeshift darkened room akin to an old-time photographer’s camera hood. In contrast, even in the dark of night, heavy rain or awkward confined spaces may pose their own barriers to easily visualizing vocal cords. Therefore, many of the classical techniques used by other practitioners in more traditional settings would not be as effective in the fast-paced, poorly controlled and mobile prehospital settings where resources and support are limited (Figure 1).Figure 1


Prehospital endotracheal intubation: elemental or detrimental?

Pepe PE, Roppolo LP, Fowler RL - Crit Care (2015)

Endotracheal intubation in the out-of-hospital setting. In the early years of out-of-hospital emergency medical services (EMS) systems, advanced life support personnel were not only trained in the nuances of how to avoid overzealous ventilation and properly place an endotracheal tube in very challenging circumstances, but they were also well-supervised on-scene by expert physicians who themselves were highly-experienced and exceptionally familiar with those challenges as well as methods to overcome them (photo by Dr. Paul Pepe).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4440604&req=5

Fig1: Endotracheal intubation in the out-of-hospital setting. In the early years of out-of-hospital emergency medical services (EMS) systems, advanced life support personnel were not only trained in the nuances of how to avoid overzealous ventilation and properly place an endotracheal tube in very challenging circumstances, but they were also well-supervised on-scene by expert physicians who themselves were highly-experienced and exceptionally familiar with those challenges as well as methods to overcome them (photo by Dr. Paul Pepe).
Mentions: Unlike the controlled in-hospital environment, in a sunny, bright outdoors setting, the ambient light causes glare and pupillary constriction for the rescuers. This circumstance requires that the practitioners are taught and understand the ‘tricks of the trade’, such as placing a coat or blanket over one’s head (and the head of the patient) in order to create a makeshift darkened room akin to an old-time photographer’s camera hood. In contrast, even in the dark of night, heavy rain or awkward confined spaces may pose their own barriers to easily visualizing vocal cords. Therefore, many of the classical techniques used by other practitioners in more traditional settings would not be as effective in the fast-paced, poorly controlled and mobile prehospital settings where resources and support are limited (Figure 1).Figure 1

Bottom Line: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care.Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015.Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, USA. Paul.Pepe@UTSW.edu.

ABSTRACT
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Show MeSH