Airway, Breathing or Consequences

Use Your Tools and Trust the Technology

Successful airway management and the unfortunate legal consequences patient care providers can face

Alternative Airways

The Who, What, Where, When and How

Understanding the options between the BVM and the ETT

PEDIATRICS AND AIRWAY MANAGEMENT

The Evolution of Excellence in Pediatric Emergency Care

The ‘Pit Crew’ Approach to Pediatric Resuscitation

Ready at a Moment's Notice

PEDIATRIC ALTERNATIVE AIRWAYS:
WHAT YOU NEED TO KNOW AND WHERE TO FIND IT.

The first of a two-part series looks at colors, cuffs, and CO2.

Preemies to Preschoolers

In the wonderful world of emergency medicine and emergency medical services (EMS), few situations can test our skills and knowledge as much as a newborn or young child in need of ventilatory assistance. Part of the stress we experience is a direct result of not asking certain questions often enough to allow the answers to be readily available to us when we are most in need of them...

Yet Another Piercing to Play With: Removal of Surface Anchors

Do you know your body jewelry ABCs—anchors, barbells, and captive bead rings? In emergency departments around the world, it has become almost commonplace to encounter patients with various types of body modifications, including tattooing and body piercings. Just when you might have thought you had seen it all, along comes a new “kid on the block"...

Breasts, Bellies, Below & Beyond

Body modifications or body art, whether tattooing,body piercing,or implants, have been practiced in become increasingly common to remove body jewelry for...

Puncturing Myths About Body Piercing

Can a patient with a tattoo safely have an MRI? The answer to this and other piercing questions...

Infective Endocarditis After Body Art

World cultures have documented the presence of tattooing and piercing for thousands of years. However, in the past two decades, the "social reality" [1] of body art has moved into the mainstream and become commonplace, especially among adolescents and young adults 15-30 years of age [2]. Several studies, including a recent sequential survey [3]examining body piercing in college studentshave documented prevalency rates of 33% to 51% since 2002...

Tubing and Tongues: Body Piercing and Airway Management

Body modification has been practiced in cultures around the world for thousands of years. The ramifications of body piercing on anesthesia practice and airway management have become more evident in recent years. This article reviews the techniques for removal of tongue jewelry and options for maintaining oral piercing patency...

Breathing For Babies

The presentation of a newborn to EMS personnel often causes a great deal of stress. What size equipment to use, and how hard and how fast to “bag” are just two of the issues that can cause concern. This article reviews special considerations, techniques and equipment required for managing respiratory resuscitation of newborns in emergency situations...

Infant Intraosseous Infusion

In the NICU Setting, it is very rare that intravenous (IV) access cannot be obtained, whether via the umbilical venous route or the peripheral. However, what about these situations: the three-week-old infant who becomes septic and the umbilical vein is no longer an option or the four-day-old infant who presents to the emergency department in cardiac arrest with yet undiagnosed congenital heart disease?...

Just Hanging Around: Questions and Answers about Body Suspension

It’s Saturday night at 3 AM and a 24-year-old heavily pierced and tattooed man presents to triage with multiple lacerations on his arms and legs. In obtaining the initial history, it is found that he was undergoing a body suspension at a local club and “the hooks ripped out.”

Masks, Math, and Midazolam

Internationally, sedation of paediatric patients for short procedures is becoming a common treatment option in a variety of areas outside of the operating theatre . However, there are controversies about sedation/pain management and appropriate monitoring, especially in Emergency Department environments. What needs to be monitored , how often , and why?...

Learn How and When to Remove Jewelry From Pierced Patients

Tucked into the pastoral hills of northeastern Ohio, the rural community of Bryan, population 8,389, isn't the sort of place most people envision when they think about body piercing. The largely blue-collar residents of the William County seat take pride in its small-town atmosphere, characteristic of farming communities throughout the nation's heartland...

Tubing Tiny Tots: Neonatal Intubation Q&A

Equipment wise, adults are easy. Young or old, they all get a 7.5 or an 8.0 endotracheal tube (ETT). Babies (“TOT’s” and “BOB’s”) and their respective airways come in various sizes; therefore, it’s not quite that easy...

Counting Fingers & Playing Baseball: Infant Venous Access Update

Just as you handle infants gently, so should you handle their veins. They are delicate, small (not much bigger than the diameter of embroidery thread!), and prone to ‘blow.’ When inserting the cannula, go slowly and...

Infant Immobilization and Pediatric Papooses

Whether you call it ‘‘Brutane’’ or just ‘‘brute force,’’ when coupled with the understanding that ‘‘I’m bigger and therefore I win,’’ you have a formula for the immobilization of infants and children that has been used for countless years in various aspects of pediatrics and emergency care. Perhaps this is the time to re-evaluate past practices and look for better, safer, more ‘‘patient friendly’’ equipment...

Tape It Like You Mean it! Securing Pediatric Endotracheal Tubes

Duct tape is like the Force... it has a light side, a dark side, and it holds the universe together... Whether for respiratory failure, head trauma, or surgical interventions, oral intubation of children is commonly performed. For the most part, unless one does anaesthesia...

A "Hole" New World

In 2005, The Association of Professional Piercers has their annual meeting with about 800 attendees who claim to preform on average 1,000 piercings per year...

Professional Piercers on Call

In the world of health care there is now yet another language to understand: that of body piercing. A 2002 study regarding body piercing of undergraduate students...revealed that 51% of students had something pierced "beyond their ears."...

Emergency: Color-Coding Children

Few situations instill more fear in the hearts of even the most experienced nurses than those involving a critically ill or arresting child. Resuscitation courses such as the Pediatric Advanced Life Support Course and the Emergency Nursing Pediatric Course have been invaluable in training emergency and pediatric nurses in the priorities for resuscitation, but they may not be enough...

Do You know Your ABC's? Airway, Breathing, & Colour Coding

When most emergency medical caregivers are asked about the type of patients who truly inspire fear, more often than not, the answer is ‘‘children’’. Why is there this inverse relationship between the age of the patient and the caregiver’s level of anxiety? Perhaps the answer to this question is...

Intraosseous Infusion: Not Just for Kids Anymore

The potential use of intraosseous (IO) infusions for adults was first examined 80 years ago. Until very recently, this procedure was most commonly considered a rescue technique for pediatric patients, and then only after all else had failed. However, the use of IO access is making a comeback!...

Big Head, Little Body and Beyond

If one asks what kinds of patients in still anxiety in even the most experienced of emergency nurses, burns and children are the typical answers. When confronted with the initial resuscitation and stabilisation of a critically ill or injured child, the acronyms of "sick or not sick", and "pink, warm,sweet, and safe" can easily summarize...

Catch, Clamp, & Don't... Emergency Newborn care Q&A

When emergency caregivers are asked what type of patients they truly most fear caring for, children and even worse, babies, are the common answers. However, what do we know about what we do everyday? Can it always get worse? Absolutely! Therefore, what is worse than having to care for a child is when a pregnant woman screams those immortal words...‘‘I’ve got to push!’...

Pediatric Spinal Immobilization

Whether in the prehospital EMS environment or the hospital emergency department the standard approach to Hienrs has included the age-old phrase "everyone has a cervical spine (C-spines) injury until proven otherwise."...

End-Tidal CO2 Verification of Endotracheal Tube Placement in Neonates

Endotracheal tubes are misplaced more ofter than one may think, and the consequences of not quickly detecting and correcting the error can be catastrophic...

Unexpected Outcome

Sunday started off like any other morning with young children- finding shoes, mediating arguments and, today, church. During the Mass, the priest stopped abruptly...

Pediatric Defibrillation A Window of Opportunity

It's hard to recall life before difibrillators. However, in the scheme of medical developments, defibrillators are a realtively new invention...

Near-Drowning Prognoses and Prevention

Drowning is a significant and preventable cause of death in children across the world. Early indicators for 2001-2 suggest that at least 251 incidents occurred in Australia, with 44 of these being children under five years old...

Verification of ET Tube Placement with ETCO2

The properly placed endotracheal tube provides the definitive protected airway and is crucial to ensuring adequate ventilation in the event of cardiac arrest, respiratory failure, or significant trauma. Although unrecognized esophageal placement is rapidly fatal, it is not harmful if it is recognized quickly...

Pediatric Defibrillation Concerns and Opportunities

In 1947, after completing thoracic surgery, Dr. Charles Beck noted that his patient was experiencing what appeared to be a ventricular fibrillation cardic arrest. Fortunately for the patient, Dr. Beck had in his laboratory what would turn out to be the first defibrillator used on a human patient...

Don't Become Unglued by Pediatric Stabilization

It's Saturday night in a community hospital's ED. A mother, cradling her heavily bundled infant(in July, mind you), cries out, "There's something wrong with my baby!"...

Ecstasy

When one thinks of the drugs commonly associated with overdose, heroin, cocaine, and alcohol come to mind. However,throughout the United States and around the world, methylenedioxymethamphetamine (MDMA), also known as Ecstasy,is becoming the preferred recreational drug among teenagers and young adults...

Sunday Afternoon Lessons About Heroes

It was a normal Sunday morning in our house. Helping the kids get dressed, making breakfest, and finding their shoes. Out the door and off the church. While at Mass, the priest stopped...

Emergency Care of the Crucifixion Victim

Of all the terrible ways to die, most people say that death by fire or death by drowning are the worst. If you lived 2000 years ago however, you most certainly would disagree...

Ipecac Syrup or Activated Charcoal

When confronted with a stable patient who may have ingested a poisonous or dangerous substance, you should immediately determine what it is and call the regional poison control center for guidance. These actions will quickly reveal the best - and perhaps only- course of treatment.

Pain Control for Burn Victims

Morphine, the long-standing drug of choice for patients with burn injuries, should be quickly and aggressively administered, without exception, intravenously...

And They Crucified Him

“We believe in one God. . . . He suffered, died, and was buried . . .” Each week, Catholics profess this truth, but do we really think about what we just said? When we think of crucifixion, we usually think of the physical nailing to the cross. However, the nails were just a small part of the “the utterly vile death of the cross.”...

Sedation for Nonemergent Neonatal Intubation

Intubation is a commonly performed procedure in the neonatal intensive care unit, with the urgency of the procedure determined by the hemodynamic status of the child. The technique of intubation involves placing an endotracheal tube (ETT)...

Necrotizing Fasciitis

Few phrases can make one's skin crawl like the words "flesh-eating bacteria." The term was coined by the British tabloids, whose reports on necrotizing fasciitis suggested that this infection would imminently become epidemic...

Help Make Boos Boos Better for Kids with Conscious Sedation

What do you get when you mix Ketamine, Versed, or chloralhydrate with chocolate syrup? A tasty treat that's sure to fly young patients out of the pain zone and into never-never land. All kidding aside, nurses know that getting some children to take oral medications can be difficult, if not altogether impossible...

When in Doubt, Knock 'Em Out

If you were three years old and has occasion to be seen by the ED, how do you think you'd feel about that nurse coming toward you with those objects that look suspiciously like the things your mom uses to sew the tears in the knees of your pants...

Necrotizing Fasciitis The Flesh-Eating Disease

This may sound like the title of a horror movie playing at your local theater, but in reality it could be your next transport. Little did we know it would be ours...

Pediatric Emergency Burn Care

Burns and their sequelae are difficult topics, especially in pediatric patients. None of us wants to think about children being subjected to pain, graft surgeries, and physical and emotional scars that may last a lifetime...

Pediatric Rapid Sequence Intubation

Air medical transport was requested to the scene of a multiple victim accident in which a car had struck a tree. On arrival, the flight crew found a 2-year-old girl with severe head and abdominal injuries as evidenced by clenched teeth, decerebrate posturing, and intermittent seizure activity...

The Worst Way to Die

If you could choose how you were going to die, what method would you pick? Most people say they would like to "pass away in their sleep" or "go to bed and never wake up" and why not? It's quick, easy, and, most importantly, painless...

Neurological Outcomes After Near-Drowning

A conflict arises between the desire to avoid resuscitating patients who will live only to exist in a persistent vegetative state and the desire to avoid denying even a small number of patients a chance for meaningful survival and recovery...

Persistent Pulmonary Hypertension of the Newborn

Pulmonary hypertension, though quite normal in the fetus while burden of oxygenation is on the maternal placenta, can be rapidly fatal if severe resistance to pulmonary blood flow continues as the infant attempts to make the transition to extrauterine life...

Lessons Learned From A Cold Weather Miracle

What do previously comatose patients remember about their unconscious moments of hospitalization? Voices ... they remember voices... talking to them, and about them. The following is an account of one such patient who helped emphasize the importance of a seemingly basic nursing function - talking to your patients...

Crush Injury, Combative Patient

Situation:A scene response is requested at a shopping center in a rural community. The initial report is that the patient is a man, who is trapped between the axle and the body of a motor home. He has sustained crushing neck and chest injuries. The time to the scene is 24 minutes...

The Case of the Blue Baby

Nothing in the ED setting seems to cause as much anxiety among even the most experienced nurses as a critically ill child. We are now accustomed to "common" conditions such as asthma, dehydration, and trauma, but times are changing...

Flight of an Angel

Amy was 24 years old when I helped transport her by University of Chicago (U of C) Aeromedical Network helicopter from a rural community hospital to The University of Chicago Hospitals about a year ago. At the age of 13, she had developed liver disease...