Endotracheal tube stabilization using an orthodontic skeletal anchor in a patient with facial burns

Stabilizing the endotracheal tube is of vital importance in patients suffering facial burns or trauma in the intensive care unit, as well as during a general anaesthetic procedure. Here is presented a secure method using a simple orthodontic skeletal anchorage system on the maxilla and 0.4-mm stainless steel wire that does not require any work or place any burden on the teeth or gingival tissue, and does not require extensive surgery.     

Introduction of pulse oximetry in the air medical setting

The importance of adequate oxygenation in critically ill patients is widely recognized. Pulse oximetry (PO) is a non-invasive, rapid technique of arterial hemoglobin oxygen saturation (SaO2) measurement. This report is a review of our experience using the PO during air medical transport. A chart review was conducted on patients who used air medical transport between October 1988 and March 1989. Types of patients included trauma and ICU patients who were transported from either accident scenes or outlying hospitals. SaO2 and vital sign (VS) measurements were obtained pre and postflight, and inflight interventions were documented. Four groups of patients were identified: Group 1: PO used, inflight intervention employed; Group II: PO used, no inflight intervention employed; Group III: no PO used, inflight intervention employed; Group IV: no PO used, no inflight intervention employed. A dependent, paired-t-test was used to compare pre and postflight SaO2 and VS measurements. The mean difference between pre and postflight measurements of SaO2, systolic blood pressure, and pulse rate were calculated within each group. Then, an ANOVA with post-hoc Newman-Keuls Test compared the means between the four groups. Of the 137 patients reviewed, 82 used PO and 55 patients did not due to technical or anatomic problems. Of the 82 patients who used PO, 19 received an inflight intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endotracheal tube obstruction due to impaction of the inferior turbinate

A case of inferior turbinate impaction in a nasoendotracheal tube is presented. This is an additional potentially lethal complication associated with general anesthesia.     

鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响

目的:评估在平卧位和头颈部后仰位下鼻腔气管导管固定对经鼻气管插管患者鼻部压力的影响.方法:选取择期行口腔颌面外科手术经鼻腔气管插管的患者24例(ASA分级Ⅰ～Ⅱ级,年龄18～60岁),随机分为钢丝加强型(wire-reinforced,WR)气管导管和预铸直角弯度型(Ring-Adair-Elwyn,RAE)气管导管2...     

Breaking bad medical news in a dental care setting

BackgroundDental care providers may diagnose diseases and conditions that affect a patient’s general health. The authors reviewed issues related to breaking bad medical news to dental practice patients and provide guidance to clinicians about how to do so.MethodsTo help reduce the potentially negative effects associated with emotionally laden communication with patients about serious health care findings, the authors present suggestions for appropriately and sensitively delivering bad medical news to both patients and their families in a supportive fashion.ResultsPreparing to deliver bad news by means of education and practice is recommended to help prevent or reduce psychological distress. One form of communication guidance is the ABCDE model, which involves Advance preparation, Building a therapeutic relationship or environment, Communicating well, Dealing with patient and family reactions, and Encouraging and validating emotions. An alternative model is the six-step SPIKES sequence—Setting, Perception, Invitation or Information, Knowledge, Empathy, and Strategize and Summarize. Using either model can assist in sensitive and empathetic communication.ConclusionsFor both practitioners’ and patients’ well-being, empathetic and effective delivery of bad medical news should be included in dental school curricula and continuing education courses.Practical ImplicationsDental care providers should be familiar with the oral manifestations of diseases and the care needed before the patient undergoes medical treatment and use effective communication necessary to share bad news with patients.     

Permanent internal pacemaker safety in air medical transport

Helicopter and fixed-wing air medical transportation provides an important role in the management of critically-ill patients. As the use of cardiac pacemakers continues to grow, knowledge of their expanding capabilities and sophistication is important. The environments of our "airborne intensive care units" are subject to many sources of electromagnetic and vibrational interference. Although pacemaker shielding mechanisms have become quite elaborate, further studies are needed to define their reliability in modern aircraft. Further, the possible effects of electromagnetic and vibrational interference upon inflight reprogramming require further study.     

Prehospital cricothyrotomy in air medical transport: outcome

In an attempt to determine outcome, this study reviewed the records of air medical patients undergoing prehospital cricothyrotomy (CRIC) from 1987 through 1989. The study included initial airway management, Trauma Score (TS) before and after CRIC and on arrival to the hospital, outcome, and initiator of airway--either emergency medical services (EMS) or LifeFlight air medical crew (LF). There were 68 CRIC in 3285 completed missions (2%). Patients averaged 31.4 years old with 46 males and 22 females. In rural environments, 60/68 patients were injured, with 65/68 injuries by blunt mechanisms. CRIC was performed by EMS in 24/68 patients and by LF in 44/68 patients. TS before CRIC, after CRIC, and on arrival to the hospital was not significantly different, averaging 5.8, 5.8, and 5.2. There were three complications of CRIC: two bleeds and one failure to insert. Five CRIC were changed to another airway at the receiving facility. Twenty-one out of 68 patients survived to discharge. There were no statistically significant differences in complications or overall mortality between LF and EMS CRIC. Prehospital CRIC appeared safe and complications were infrequent. The CRIC, once placed, remained the airway of choice in most patients. The eventual outcome in this population suggested serious injury with the majority of patients (69%) dying.     

Fetal monitoring during air medical transport

A prior survey of physiologic monitoring practices during maternal air medical transport by helicopter found that cardiotocography is rarely utilized. The authors report their experience with fetal heart-rate monitoring during helicopter transport of high-risk mothers. The technique is as readily applied to the care of the patient in a helicopter as it is in the modern labor and delivery suite. The study found no substantial reasons why such monitoring should not be used in air medical transport.     

Airway management and air medical transport

A 5-year retrospective review of airway management by flight nurses was conducted to evaluate airway care and to determine the frequency of surgical cricothyrotomy. Intubation was attempted in 51% of patients, with a success rate of 80%. Oral intubations were attempted in the remaining patients and in those patients in whom initial attempts at nasal intubation failed, with a success rate of 81%. The success rate for intubations was 72% in 1985, 95 % in 1986, 92% in 1987, 97% in 1988, and 76% in 1989. Overall, 87% of patients were successfully intubated and surgical cricothyrotomy was required in only one patient. A greater success rate was achieved when intubations were performed before takeoff than during flight.     

The development of air medical services in Czechoslovakia

The Czechoslovakian system of centralized dispatch of all emergency medical services prevents competition between ground ambulances and air medical services. Although this program is less than two years old, remarkable progress has pushed Czechoslovakia to the forefront of modern-day air medical transport. However, the future of Czechoslovakian air medical transport will require the acquisition of better-performing EMS helicopters and accessibility to medical equipment using Western technology. As with all current United States helicopter EMS systems, Czechoslovakia will face many of the financial considerations required in funding this extensive and elaborate project.