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Terry T. Steele (860) 679 - 9285 | |
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| Airway World Annual Report | |
 Events and Growth in 2011.
Last year was a fantastic year in Airway World! It was a year characterized by lots of great events, membership growth and international expansion.
Airway World was host to eleven live events in 2011. These events focused on airway management in trauma, air medical transport, patients in shock and pediatrics. Additional events focused on airway research and low cost medical devices. The live and recorded versions of these events were viewed close to 1,500 times!
In 2011, Airway World attracted 1,378 new members, bringing the total to 3,738! Some membership statistics:
- Most members specialize in anesthesiology/anesthesia (35%), EMS/pre-hospital care (24%), Emergency Medicine (24%) and Critical Care (6%). Others work in the fields of respiratory therapy, family medicine, pediatrics, hospital medicine, oral and maxillofacial surgery, sedation dentistry, ENT, urgent care, obstetrics and pulmonary disease.
- Members hail from 64 different countries - up 36% from 2010. Most members come from the United States, Canada, Australia, Great Britain and Saudi Arabia.
- Forty-four percent (44%) of Airway World members work in hospitals or outpatient facilities. Others work in EMS agencies or fire departments, educational institutions, group practices and the military.
New research summaries, videos, articles, recorded webinars, custom meeting rooms and booths were added in 2011!
Since launch, Airway World members made over 10,000 visits to Airway World, watched more than 12,000 videos and viewed over 5,600 documents. One very active member visited Airway World 85 times over 6 months in 2011!
Haven't been to Airway World yet? Register today to begin exploring the educational resources and events that keep people coming back for more! |
| Corticosteroids Impart No Benefit After Single-Dose Etomidate for Intubation | |
 Moderate-dose hydrocotisone infusion did not affect outcomes in intubated patients without septic shock who had etomidate-related adrenal insufficiency.
Some physicians have expressed concern about adrenal suppression associated with etomidate use, but is this suppression clinically relevant? Researchers in France prospectively studied 97 patients with acute medical or traumatic conditions without septic shock who underwent intubation with etomidate plus succinylcholine in the prehospital or emergency department settings. Patients were randomized to receive continuous infusions of hydrocortisone (200 mg/day) or saline for 42 hours, starting 6 hours after intubation. Postintubation sedation was maintained with a variety of sedative and analgesic agents (not etomidate). Patients received vasopressor support and insulin as required to maintain target mean arterial blood pressure of 65 to 90 mm Hg and serum glucose levels of <10 mmol/L.
Six hours after etomidate administration, 91% of patients randomized to the hydrocortisone group and 84% randomized to the control group met criteria for adrenal insufficiency based on corticotrophin stimulation tests and serum hormonal assays. No significant differences were noted between groups in rate of decline of Sequential Organ Failure Assessment scores, duration of mechanical ventilation, length of stay in the intensive care unit, or 28-day mortality.
Comment: Hydrocortisone treatment is not without risk and does not seem to benefit the group of patients studied. Etomidate, with its stable cardiovascular profile, remains an induction agent of choice for emergency intubation, particularly in multitrauma patients with brain injury whose outcomes might be worsened by inadequate systemic blood pressure for cerebral perfusion. - Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine January 13, 2012
Citation(s):
Payen JF et al. Corticosteroid after etomidate in critically ill patients: A randomized controlled trial. Crit Care Med 2012 Jan; 40:29.
Marik PE. Etomidate in critically ill patients: Is it safe? Crit Care Med 2012 Jan; 40:301.
Copyright © 2012. Massachusetts Medical Society. All rights reserved. Used with permission. |
| Save The Date! | |
Quarterly Airway Research Review (Webinar)
Ron M. Walls, MD
March 9, 2012
2:00 PM EST
Airway World Auditorium
It's easy to stay current in the field of airway management with these quarterly research reviews! Dr. Walls selects the most relevant research from recently published articles, shares their results and discusses their impact on the practice of emergency airway management. Participants can submit questions and comments to Dr. Walls during and after the presentation (via an accompanying chat box).
For an Outlook Reminder: 1. Click here. 2. Open. 3. Save.
Coming in April and May...
Obesity and Airway Management
Ventilation in EMS Airway Management
Follow us on Twitter for announcements of upcoming events! |
| Airway Challenge #5: A Rough Two Days | |
 The Case
A full term 2 day-old boy has been persistently vomiting and has been in the neonatal intensive care unit since birth in a community hospital. After delivery, the baby was vigorous, and had APGAR scores of 9/9. The neonatologists order an abdominal x-ray which reveals multiple air-fluid levels indicative of small bowel obstruction. The surgeons are worried about intestinal perforation and want to operate emergently. You are on call and immediately attend to the baby for assessment. You notice severe micrognathia, with indrawing of the chest, indicative of upper airway obstruction. The neonatologist also mentions that this child may have Pierre Robin syndrome.
Physical examination:
Vital signs: HR 166; RR 44; BP 70/30; SpO 93%. On 4 liters via nasal cannula; peripheral intravenous line in place.
What would be the most appropriate next steps in managing this child's airway for surgery?
- Rapid sequence induction with propofol and succinylcholine followed by direct laryngoscopy with a bougie.
- Rapid sequence induction with ketamine and rocuronium followed by intubation with a video laryngoscope.
- "Awake" placement of a supraglottic device followed by flexible fiberoptic tracheal intubation.
- Call ENT to perform a tracheostomy after inducing and maintaining general anesthesia with Sevoflurane via mask ventilation.
- Administer 1mg/kg of intravenous ketamine, followed by a look with a video laryngoscope.
- Initiate CPAP and transfer patient to a tertiary care pediatric center.
Click here to enter your response, view the correct answer and see how your colleagues responded.
Click here to view the full case discussion by Narasimhan Jagannathan, MD, Department of Pediatric Anesthesia, Children's Memorial Hospital, Chicago. |
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