ABSTRACT
BACKGROUND: Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied. METHODS: We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers. One hundred sixty-eight adult patients requiring prehospital emergency intubation were treated by an emergency physician and randomized to 1 of 3 portable videolaryngoscopes (A.P. Advance, C-MAC PM, and channeled blade KingVision) with different blade types. The primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices. P values for pairwise comparisons are corrected by the Bonferroni method for 3 tests (P[BF]). All presented P values are adjusted for center. RESULTS: Glottis visualization was comparable with all 3 devices. Overall intubation success for A.P. Advance, C-MAC, and KingVision was 96%, 97%, and 61%, respectively (overall: P < .001, A.P. Advance versus C-MAC: odds ratio [OR], 0.97, 95% confidence interval [CI], 0.13-7.42, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001; C-MAC versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001). Intubation success on the first attempt with A.P. Advance, C-MAC, and KingVision was 86%, 85%, and 48%, respectively (overall: P < .001, A.P. Advance versus C-MAC: OR, 0.89, 95% CI, 0.31-2.53, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.24, 95% CI, 0.055-0.38, P[BF] = 0.0054; C-MAC versus KingVision: OR, 0.21, 95% CI, 0.043-.34, P[BF] < 0.003). Direct laryngoscopy for successful intubation with the videolaryngoscopic device was necessary with the A.P. Advance in 5 patients, and with the C-MAC in 4 patients. In the KingVision group, 21 patients were intubated with an alternative device. CONCLUSIONS: During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.
Subject(s)
Airway Management/methods , Emergency Medical Services/methods , Intubation, Intratracheal/methods , Laryngoscopy/methods , Physician's Role , Video Recording/methods , Adult , Aged , Aged, 80 and over , Airway Management/instrumentation , Airway Management/standards , Emergency Medical Services/standards , Female , Humans , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/standards , Laryngoscopy/instrumentation , Laryngoscopy/standards , Male , Middle Aged , Prospective Studies , Video Recording/standards , Young AdultABSTRACT
Rescue helicopters are used for emergency care and transport of emergency patients. The dimension of the cabin is clearly limited. A transport is carried out under spatial narrowness and high noise levels. Acoustic alarms or noises caused by the patient are hardly to be perceived, so that the view at optical alarms is necessary. Environmental conditions affect the concentration on the patient. Rearrangement maneuvers represent the most critical phases. Always the whole apparative monitoring and respirator must be in the field of view of the emergency doctor, drugs to the care must be handy to be quickly administered, the quantity of oxygen has to be observed. Infusions and option of airway management are ready to set in advance. Standardized work with the aid of algorithms and knowledge of treatment recommendations and guidelines help to prevent errors. To optimize the care of emergency patients, special training courses for the crew of rescue helicopters are offered. A training simulator to practice different scenarios and the establishment of a CIRS system are recommended.
Subject(s)
Air Ambulances/organization & administration , Anesthesia/methods , Anesthesiology/organization & administration , Delivery of Health Care/methods , GermanyABSTRACT
This case report describes the prehospital care of a 42-year-old person damaged by a severe motorcycle accident in a rural scene. The injured person was unconscious, one pupil was dilated and rib fractures were palpable. Purposeful therapy without delay was necessary. The prehospital therapy took 35 minutes in total. The time benefit by using a rescue helicopter is illustrated: time to initial treatment is minimized and duration of transport as well - direct transport to a trauma center is possible.
Subject(s)
Accidents, Traffic , Air Ambulances/organization & administration , Emergency Medical Services/methods , Emergency Medical Services/organization & administration , Multiple Trauma/therapy , Adult , Germany , Humans , Male , Treatment OutcomeABSTRACT
This case report describes the prehospital care of a person after an occupational accident. The amputation of whole extremities is rare and needs a standardized procedure: at first lifesaving procedures are necessary before saving the limb. The work at a conveyor belt resulted in taking of an arm. On the basis of this case report the prehospital management is discussed focalizing the complete treatment of the patient and his amputated extremity as well as the transport from the scene of accident to a suitable hospital.
Subject(s)
Accidents, Occupational , Amputation, Surgical/methods , Emergency Medical Services/methods , Emergency Medical Services/organization & administration , Transportation of Patients/methods , Transportation of Patients/organization & administration , Upper Extremity/surgery , Adult , Germany , Humans , MaleABSTRACT
On the basis of a case report the prehospital management of a newborn child with deep accidental hypothermia (22oC) is discussed. The child was found in a garbage can. The continuous resuscitation during the transport into the clinic is done in an incubator and the child survives without neurologic damages. The used measures of the resuscitation are discussed on the basis of the therapy.
Subject(s)
Air Ambulances , Child, Abandoned , Emergency Medical Services/methods , Hypothermia/therapy , Incubators, Infant , Infant, Newborn, Diseases/therapy , Adoption , Body Temperature , Follow-Up Studies , Humans , Infant, Newborn , Male , Neurologic Examination , Resuscitation/methods , RewarmingABSTRACT
On the basis of a case report the prehospital management of severely burned patients is discussed. The prevention of hypovolemia, hypothermia or hypoxemia are the primary targets. It is necessary to estimate the burn size and depth. The burn shock fluid resuscitation, prevention of hypothermia, pain- and airway management are described as well as the transport from the scene of accident to a proximal emergency unit or to a specialized burn intensive care unit.
Subject(s)
Burns/diagnosis , Burns/therapy , Critical Care/methods , Emergency Medical Services/methods , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians'ABSTRACT
This case report describes the prehospital care of a person with severe polytrauma due to being jammed in a vehicle in a traffic accident. After understanding the forces involved in causing the trauma, the therapy of impaired vital functions is demonstrated with particular regard to time management. Use of a rescue helicopter allowed for minimizing the delay to initial treatment as well as the duration of transport.
