Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 24
Filter
1.
Cureus ; 16(5): e60149, 2024 May.
Article in English | MEDLINE | ID: mdl-38864059

ABSTRACT

We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.

2.
Resuscitation ; 199: 110198, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38582443

ABSTRACT

INTRODUCTION: Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes. METHODS: We conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders. RESULTS: We analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73-88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and the witnesses intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/407). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39-0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23-3.95). CONCLUSION: Bystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients.


Subject(s)
Airway Obstruction , Foreign Bodies , Registries , Humans , Male , Airway Obstruction/etiology , Airway Obstruction/therapy , Airway Obstruction/mortality , Female , Aged , Aged, 80 and over , Prospective Studies , Japan/epidemiology , Foreign Bodies/complications , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/statistics & numerical data
3.
Resuscitation ; 198: 110171, 2024 May.
Article in English | MEDLINE | ID: mdl-38461889

ABSTRACT

BACKGROUND: Foreign body airway obstruction (FBAO) stands as an important contributor to accidental fatalities, yet prompt bystander interventions have been shown to improve survival. This study aimed to evaluate the incidence, interventions, and survival outcomes of patients with out-of-hospital cardiac arrest (OHCA) related to FBAO in comparison to patients with non-FBAO OHCA. METHODS: In this population-based cohort study, we included all OHCAs in Denmark from 2016 to 2022. Cases related to FBAO were identified and linked to the patient register. Descriptive and multivariable analyses were performed to evaluate prognostic factors potentially influencing survival. RESULTS: A total of 30,926 OHCA patients were included. The incidence rate of FBAO-related OHCA was 0.78 per 100,000 person-years. Among FBAO cases, 24% presented with return of spontaneous circulation upon arrival of the emergency medical services. The 30-day survival rate was higher in FBAO patients (30%) compared to non-FBAO patients (14%). Bystander interventions were recorded in 26% of FBAO cases. However, no statistically significant association between bystander interventions or EMS personnels' use of Magill forceps and survival was shown, aOR 1.47 (95 % CI 0.6-3.6) and aOR 0.88 (95% CI 0.3-2.1). CONCLUSION: FBAO-related OHCA was rare but has a higher initial survival rate than non-FBAO related OHCA, with a considerable proportion of patients achieving return of spontaneous circulation upon arrival of the emergency medical service personnel. No definitive associations were established between survival and specific interventions performed by bystanders or EMS personnel. These findings highlight the need for further research in this area.


Subject(s)
Airway Obstruction , Cardiopulmonary Resuscitation , Emergency Medical Services , Foreign Bodies , Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/therapy , Out-of-Hospital Cardiac Arrest/mortality , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/etiology , Denmark/epidemiology , Male , Female , Incidence , Aged , Middle Aged , Airway Obstruction/epidemiology , Airway Obstruction/etiology , Airway Obstruction/therapy , Airway Obstruction/mortality , Emergency Medical Services/statistics & numerical data , Emergency Medical Services/methods , Cardiopulmonary Resuscitation/statistics & numerical data , Cardiopulmonary Resuscitation/methods , Foreign Bodies/complications , Foreign Bodies/epidemiology , Registries , Survival Rate/trends , Aged, 80 and over , Adult , Cohort Studies
4.
Resuscitation ; 188: 109806, 2023 07.
Article in English | MEDLINE | ID: mdl-37088269

ABSTRACT

AIM: Foreign body airway obstruction (FBAO) due to food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes. METHODS: We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents due to food in the hospital from January 2010 to June 2021 and collected data on the characteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents. RESULTS: We identified 300 patients who had a FBAO incident from food. The most common age group was 80-89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in successful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one-third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from these incidents. CONCLUSION: FBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.


Subject(s)
Airway Obstruction , Foreign Bodies , Humans , Aged, 80 and over , Death , Airway Obstruction/epidemiology , Airway Obstruction/etiology , Airway Obstruction/therapy , Foreign Bodies/complications , Foreign Bodies/epidemiology , Hospitals , Morbidity
5.
Prehosp Disaster Med ; 38(3): 326-331, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36938681

ABSTRACT

INTRODUCTION: Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department. STUDY OBJECTIVE: The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. METHODS: In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated. RESULTS: Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year's Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001). CONCLUSIONS: Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.


Subject(s)
Airway Obstruction , Cardiopulmonary Resuscitation , Emergency Medical Services , Foreign Bodies , Out-of-Hospital Cardiac Arrest , Infant , Humans , Japan/epidemiology , Tokyo/epidemiology , Airway Obstruction/therapy , Prognosis , Cardiopulmonary Resuscitation/adverse effects , Out-of-Hospital Cardiac Arrest/therapy , Out-of-Hospital Cardiac Arrest/etiology , Foreign Bodies/complications
6.
Children (Basel) ; 9(11)2022 Oct 26.
Article in English | MEDLINE | ID: mdl-36360350

ABSTRACT

Airway obstruction refers to suffocation caused by blockage of the airway due to a foreign body and is a common cause of accidental death in infants below one year of age. However, the current infant CPR manikins used for training in first aid for foreign body airway obstruction can only be applied to one single scenario. Furthermore, trainees' first aid skills cannot be recorded and quantified with a digital system and, consequently, assessment of their skills is difficult to conduct. This study aims to overcome the technical limitations by developing an AR-based assessment system for training in first aid for infant airway obstruction. With this assessment system, trainees can learn first aid more efficiently and correctly and conduct a quantitative assessment of their skills digitally. For instructors, the time required for assessment, potential human error, and the cost of training can also be reduced. The system can be a practical learning tool that helps trainees assess emergencies and integrate their knowledge and skills.

7.
Article in English | MEDLINE | ID: mdl-35409529

ABSTRACT

Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient's age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2−80) and 73 (Dechoker©, 5−84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms.


Subject(s)
Airway Obstruction , Foreign Bodies , Airway Obstruction/therapy , Child, Preschool , Foreign Bodies/therapy , Humans , Prospective Studies , Retrospective Studies , Suction
8.
Acute Med Surg ; 9(1): e741, 2022.
Article in English | MEDLINE | ID: mdl-35309267

ABSTRACT

Aim: Foreign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO. Methods: This multicenter retrospective observational study was carried out among patients with life-threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge. Results: Among 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01-1.07) was associated with vegetative state or death. When the cut-off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut-off value of 4 min, the negative predictive value was 1.00. Conclusion: Longer airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.

9.
Cureus ; 14(1): e20918, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35154915

ABSTRACT

Background Foreign body airway obstructions (FBAOs, choking) are a significant cause of preventable mortality. Abdominal thrusts, back blows, and chest compressions are traditional interventions. However, suction-based airway clearance devices (ACDs) have recently been marketed as an alternative. Of note, there is limited published evidence regarding their efficacy and safety. Our research has two aims: (1) to investigate what situational and patient factors are frequently identified, and which are associated with relief of the FBAO and survival in individuals with FBAOs treated with an ACD; and (2) to describe the experience of individuals who have used ACDs in response to a FBAO and identify facilitators and barriers to the use of ACDs compared to traditional interventions. Methods and analysis A prospective database will be developed using an online reporting system to capture ACD uses, independent of manufacturers, from July 1st, 2021 to December 31st, 2023. Descriptive statistics will be used to summarize cases, outcomes, and adverse events. Clinically important subgroups will be stratified for analysis, including the severity of obstruction, patient demographics, and training of ACD users. Semi-structured interviews will also be conducted with a subset of ACD users to describe in detail their experience using the device. Themes from these interviews will be assessed using the theoretical domains framework. Discussion This study will improve the evidence surrounding ACDs and compare it to current data for traditional techniques, with the aim of optimizing FBAO treatment. Data on ACDs are urgently needed as these devices are already being used by parents, caregivers, lay rescuers, and healthcare professionals to respond to choking emergencies. This evaluation will provide important information about their effectiveness and any safety concerns which can inform the public, resuscitation guidelines, and future research studies.

10.
Intern Emerg Med ; 17(1): 187-190, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34637078

ABSTRACT

Foreign body (FBA) in the airway is a common cause of sudden onset of respiratory distress in children. Prompt recognition and early intervention is required to minimize the potentially serious and sometimes fatal consequences.


Subject(s)
Foreign Bodies , Subcutaneous Emphysema , Child, Preschool , Dyspnea , Foreign Bodies/diagnosis , Foreign Bodies/diagnostic imaging , Humans , Subcutaneous Emphysema/etiology
11.
Respir Med Case Rep ; 34: 101542, 2021.
Article in English | MEDLINE | ID: mdl-34765436

ABSTRACT

Paediatric plastic bronchitis (PB) is a rare disease characterized by the presence or expectoration of branching airway casts usually in children with cardiac conditions and allergy. It is thought to be due to obstruction or altered drainage of the lymphatics in those with cardiac conditions. Obstruction can be diffuse and thus fatal if untreated. Less than 600 cases have been described in literature and just one in our region in a patient with sickle cell disease. We present a case of a 7-year-old female with acute symptoms suggestive of a lower respiratory tract infection and left hemithorax opacification and bronchial casts on bronchoscopy.

12.
Resusc Plus ; 7: 100140, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34223396

ABSTRACT

OBJECTIVES: Several studies have examined the association between advanced airway management (AAM) and survival for arrest that is non-shockable, noncardiac in origin, or due to suffocation; however, the efficacy of prehospital AAM compared with no AAM following foreign body removal by emergency medical services (EMS) has not been examined. We aimed to compare neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA) due to foreign body airway obstruction (FBAO) managed with and without AAM after foreign body removal. METHODS: This retrospective observational cohort study used all emergency transportation data of Japan and the All-Japan Utstein Registry. We included patients with OHCA aged ≥18 years undergoing resuscitation and removal of airway foreign bodies by EMS from January 2015 to December 2017. The exposure of interest was prehospital AAM by EMS after foreign body removal, and the primary outcome was a favorable neurological outcome at hospital discharge (i.e., a cerebral performance category of 1-2). RESULTS: Overall, 329,098 adults had OHCAs and 23,060 had foreign bodies removed from their airways; 3681 adult patients met our eligibility criteria and were divided as: AAM (2045) and non-AAM (1636) groups. Propensity score matching resulted in 1210 matched pairs with balanced baseline characteristics between the groups. The rate of favorable neurological outcome was significantly lower in the AAM group than in the non-AAM group (OR 0.34, 95% CI 0.19-0.62). However, survival was not significantly different between the two groups (OR 1.08, 95% CI 0.84-1.37). CONCLUSIONS: We have not demonstrated the benefit of AAM for patients with OHCA due to FBAO. Further study will be required to confirm the efficacy of AAM for those patients.

13.
Resuscitation ; 156: 174-181, 2020 11.
Article in English | MEDLINE | ID: mdl-32949674

ABSTRACT

OBJECTIVE: To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO). METHODS: We searched MEDLINE, EMBASE, and the Cochrane library from inception on 30th September 2019 for studies that described the effectiveness of interventions to treat FBAO in adults and children. We included randomised controlled trials, observational studies and case series (≥5 cases) that described evidence of benefit. For evidence of harm/complications, we included case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias. Data are summarised in a narrative synthesis. The GRADE system is used to assess evidence certainty. RESULTS: We included 69 publications, comprising three cross-sectional studies (557 patients); eight case series (755 patients), and 59 were case reports (64 patients). One paper was included as a case series and cross-sectional study. For all interventions and associated outcomes, evidence certainty was very low. Early removal of FBAO by bystanders was associated with improved neurological survival (odds ratio 6.0, 95% confidence interval 1.5 to 23.4). Identified evidence showed that key interventions (back blows, abdominal thrusts, chest thrusts/compressions, Magill forceps, manual removal of obstructions from the mouth, suction-based airway clearance devices) are effective in relieving FBAO. We identified reports of harm in relation to back blows, abdominal thrusts, chest thrusts/compressions, and blind finger sweeps. CONCLUSIONS: Key interventions successfully relieve FBAO, but may be associated with important harms. Guidelines for FBAO management should balance the benefits and harms of interventions.


Subject(s)
Airway Obstruction , Foreign Bodies , Adult , Airway Obstruction/etiology , Airway Obstruction/therapy , Bias , Child , Cross-Sectional Studies , Foreign Bodies/complications , Foreign Bodies/therapy , Humans
14.
Front Public Health ; 8: 541885, 2020.
Article in English | MEDLINE | ID: mdl-33425826

ABSTRACT

Foreign Body Airway Obstruction (FBAO) is a medical emergency that can result in death, particularly if swift, appropriate action is not taken. It can be a frightening experience for all involved. DeChoker, an Airway Clearance Device (ACD), might provide an additional alternative in the management of choking; however, limited evidence around its safety and effectiveness makes adoption controversial. Objectives: An independent evaluation to explore the experiences of health and care professionals who used DeChoker in real-life adult choking emergencies, focusing on the product's safety, efficacy and ease of application. Design: Retrospective mixed methods case study, with multiple embedded units of analysis. Setting: UK adult care homes. Participants: Twenty seven incidents of adult choking emergencies self-reported by care home staff where DeChoker was used. This data was augmented by an in-depth exploration of four individual choking incidences. Results: The choking victim's ages range: 45 to 101 years (mean 79.8 years). The device was reported to have successfully removed the obstruction in 26 of 27 cases, with very few complications or adverse events reported. In 21 of 27 incidents (78%) the victim was not required to visit Accident and Emergency. Qualitative data indicated nursing home staff found the DeChoker easy to use and valued its presence as an adjunct to current guideline procedures. Conclusion: There is a dearth of evidence surrounding the management of choking and little innovation in this area for five decades. This retrospective evaluation contributes to discussion regarding the role ACDs might play in the management of choking, particularly in cases where current choking management guidance are ineffective, insufficient, inappropriate or impractical (e.g., frail or movement restricted people). The interview data presents a view from care home staff that the DeChoker, as an ACD, contributed to saving the life of choking victims.


Subject(s)
Airway Obstruction , Foreign Bodies , Adult , Aged , Aged, 80 and over , Airway Obstruction/therapy , Emergencies , Humans , Middle Aged , Nursing Homes , Retrospective Studies
15.
Indian J Otolaryngol Head Neck Surg ; 71(Suppl 1): 693-695, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31742044

ABSTRACT

Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway.

16.
Resuscitation ; 138: 28-35, 2019 05.
Article in English | MEDLINE | ID: mdl-30836169

ABSTRACT

AIM: To compare dyad (training in pairs without an instructor) with resource-intensive instructor-led training for laypersons' paediatric resuscitation skills in a non-inferiority trial and examine cost-effectiveness of the training methods. METHODS: In this randomised parallel group non-inferiority trial, 155 dyad and 175 instructor-led laypersons were trained in Basic Life Support and Foreign Body Airway Obstruction Management. Dyads were given instructional videos, hands-on exercises and provided feedback to their partner for 50 min. Instructor-led laypersons trained in groups of six for two hours. Learning were assessed in scenarios immediately after training and, subsequently, at 14 days, 1, and 3 months. Pass rates, cost-effectiveness of producing a competent layperson (passing both tests), and non-inferiority were analysed. RESULTS: Sixty-eight (45.6%) dyad and 130 (74.3%) instructor-led laypersons passed the basic life support test (p < 0.001). For Foreign Body Airway Obstruction Management 77 (54.2%) dyad and 130 (79.3%) for instructor-led laypersons passed (p < 0.001). Skills decreased over three months for both groups. Forty-two (30.4%) dyad and ninety-eight (59.8%) for instructor-led laypersons were competent after training (p < 0.001). The lower effectiveness of dyad training had reduced costs (p < 0.001). For each 10,000 USD allocated to training, dyad training would result in 71 vs. 65 competent laypersons for instructor-led training. Non-inferiority of dyad training could not be established. CONCLUSION: Instructor-led training was the most effective but also the most expensive training method, making it less cost-effective than dyad training. When the aim is to train for quantity rather than quality, dyad training would be the preferred choice of training method.


Subject(s)
Airway Obstruction/therapy , Education, Nonprofessional , Foreign Bodies/complications , Out-of-Hospital Cardiac Arrest/therapy , Resuscitation , Teaching , Airway Obstruction/etiology , Child , Cost-Benefit Analysis , Education, Nonprofessional/economics , Education, Nonprofessional/methods , Educational Measurement , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Pediatrics/methods , Resuscitation/education , Resuscitation/methods , Teaching/classification , Teaching/standards
17.
Am J Emerg Med ; 37(12): 2177-2181, 2019 12.
Article in English | MEDLINE | ID: mdl-30880041

ABSTRACT

INTRODUCTION: Foreign body airway obstruction (FBAO) is a common medical emergency; however, few studies of life-threatening FBAO have been reported and no standard classification system is available. METHODS: We retrospectively evaluated patients who presented to the emergency departments of two hospitals and were diagnosed with FBAO. The primary outcome was cerebral performance category (CPC) score at discharge. To establish a new classification system for FBAO, FBAO was classified into three types based on the anatomical and physiological characteristics of the obstructed airway. RESULTS: A total of 137 patients were enrolled. Median age was 79.0 years. The most common cause of FBAO was meat, followed by bread, rice cake, and rice. Of all patients, 65.7% suffered cardiac arrest and 51.1% died. In contrast, 28.5% had favorable neurological outcomes, defined as CPC 1 and 2. Upper airway obstruction (type 1) was the most common (type 1, 78.1%), while trachea and/or bilateral main bronchus obstruction (type 2, 12.4%) showed significantly higher mortality than type 1 obstruction (82.4% vs 47.7%, P = 0.0078). Patients with unilateral bronchus and/or distal bronchus obstruction (type 3, 9.5%) were significantly more likely to consume a dysphagia diet than type 1 patients (23.1% vs 0%, P < 0.0001). CONCLUSION: The majority of patients with life-threatening FBAO were elderly and had poor neurological outcomes. Our new classification system divides FBAO into three types, and revealed that mortality was significantly higher with type 2 than type 1 obstruction. This classification system may improve the management of patients with FBAO and assessment of patient outcomes.


Subject(s)
Airway Obstruction/classification , Foreign Bodies/therapy , Aged , Aged, 80 and over , Airway Obstruction/mortality , Airway Obstruction/therapy , Bronchoscopy/statistics & numerical data , Emergency Medical Services/methods , Female , Humans , Male , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/mortality , Retrospective Studies
18.
Scand J Trauma Resusc Emerg Med ; 26(1): 73, 2018 Sep 06.
Article in English | MEDLINE | ID: mdl-30189887

ABSTRACT

BACKGROUND: Standardised courses for laypeople in Paediatric Basic Life Support (PBLS) and Foreign Body Airway Obstruction Management (FBAOM) teach essential skills for the initiation of resuscitation by bystanders. Performance assessments are necessary to ensure that skills are acquired. We aimed to examine the validity of developed performance assessments and to determine credible pass/fail standards. METHODS: Validity evidence was gathered in a standardised simulated setting by testing participants with three different levels of PBLS/FBAOM experience: untrained laypersons, trained laypersons, and lifeguards. Two blinded raters assessed participants' performance. The reliability of test scores was analysed using generalizability theory, scores were compared across the three groups, and pass/fail-standards were established. RESULTS: A total of 33 participants were included. More than two raters and two cases were necessary for PBLS to achieve a reliability coefficient above 0.80, which is considered the minimally acceptable level for high-stakes certification. For FBAOM, two tests or three raters were needed. Assessment scores differed across the three groups for PBLS skills, as well as for FBAOM skills (p < 0.001). Pass levels of 74% and 55% of the maximum score for PBLS and FBAOM, respectively, were identified as the levels that best discriminated between competent and non-competent laypersons. CONCLUSIONS: Laypersons' PBLS and FBAOM skills can be assessed in a reliable and valid way in a standardised simulated setting. However, multiple raters and scenario tests are needed to ensure sufficient reliability, which raises questions regarding the feasibility of performing certification tests for laypersons who participate in short paediatric resuscitation courses.


Subject(s)
Airway Obstruction/therapy , Cardiopulmonary Resuscitation/standards , First Aid/standards , Foreign Bodies , Helping Behavior , Adult , Certification , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Reproducibility of Results , Simulation Training
19.
Int J Emerg Med ; 11(1): 34, 2018 Aug 22.
Article in English | MEDLINE | ID: mdl-31179924

ABSTRACT

BACKGROUND: Foreign body airway obstruction is a significant public health issue around the world. Mochi, a traditional sticky rice cake in Japan, has gained popularity in many countries including the USA. However, the associated aspiration danger has not yet been well recognized. CASE PRESENTATION: We describe three cases of foreign body airway obstruction due to mochi. Case 1 was an elderly man who was brought to the emergency department by an ambulance after he choked on mochi. Despite extensive efforts to remove pieces of mochi including use of Magill forceps, bronchoscopy, and endotracheal intubation, he suffered severe hypoxia and died. Case 2 was a middle-aged man who was found unconscious in a park. The rhythm upon arrival was pulseless electrical activity. During intubation, large pieces of mochi were found in the oropharynx and removed with Magill forceps. He developed aspiration pneumonitis and hypoxic brain injury. The patient was discharged to a skilled nursing facility with severe neurological disability. Case 3 was an elderly man who choked while eating soup with mochi at home. His initial cardiac rhythm was asystole. During intubation, obvious foreign body was found in the oropharynx. Several pieces of mochi were removed by suctioning through the endotracheal tube. He suffered severe hypoxic injury and died. CONCLUSIONS: All of our cases resulted in death or poor neurological outcome. As the popularity of mochi continues to increase, it is likely that cases of aspiration from mochi will also increase. Emergency physician should be aware of the potential danger of mochi and be familiar with the techniques to remove mochi from the airway.

20.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-700649

ABSTRACT

In order to optimize the teaching process, improve the teaching quality and cultivate of emergency nursing talents with comprehensive quality, we systematically designed the teaching process of foreign body airway obstruction first aid. From the design ideas and curriculum innovation, we focused on the use of a variety of teaching methods, and we combined it with modern information technology, which demonstrated the practicability and operability of first aid skill. This teaching practice has proved that the systematically teaching reform design is helpful to improve the learning efficiency of nursing students and cultivate the comprehensive quality of students' emergency response ability.

SELECTION OF CITATIONS
SEARCH DETAIL
...