Why Not Ramp All Intubations? New RCT Suggests We Should
Bed-up-head-elevated (aka ramped) position improved glottic view with Mac direct laryngoscopy over sniffing position and was noninferior to the GlideScope laryngeal view.
Should We Use GlideScope In Neonates?
GlideScope may have some advantage to direct laryngoscopy in neonates, potentially reducing time to intubation in those with a more challenging glottic view.
How Many Intubations Are Needed for Skill Proficiency?
We may need to perform about 3 or supervise about 5 endotracheal intubations per year to maintain procedural proficiency.
How Often Do We Actually Intubate in the Emergency Department?
The average emergency physician does about ten endotracheal intubations per year. However, about one quarter of physicians perform <5 per year.
Predicting Difficult Intubation
History of difficult intubation is the biggest predictor of trouble intubating, followed by grade 3 upper lip bite and others.
Is RSI for CVA by EMS Helpful or Harmful?
Rapid sequence intubation in the prehospital setting was associated with an increase in mortality for stroke patients.
Does Ramped Position Impact Intubation Success?
There was no difference in first pass success with a non-supine (ramped) vs supine intubating position in this retrospective study, and composite adverse events were more common when ramped. But patients most likely to be ramped were also obese or had predicted difficult airway.
Advanced Airway for Pediatric Cardiac Arrest – Should We Just Bag?
There may be a slight advantage for pediatric cardiac arrest patients in survival with good neurological outcome by using simple bag-valve mask ventilation over advanced airway management.
Advanced Airway For Non-Shockable OHCA?
Advanced airway management (AAM) was associated with increased overall survival in out-of-hospital cardiac arrest (OHCA) (though not survival with favorable neurological outcome) in patients with non-shockable initial rhythm. There was no difference in survival with use of AAM in patients with initial shockable rhythm.
Paralytic or Sedative First for RSI?
There was no statistically or clinically important difference in time from drug push to tube placement for neuromuscular blocker first followed by the sedative or vice versa. But is this best?